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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005914
Report Date: 01/17/2025
Date Signed: 01/17/2025 03:33:01 PM

Document Has Been Signed on 01/17/2025 03:33 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SENIOR'S RETREAT, INC.FACILITY NUMBER:
306005914
ADMINISTRATOR/
DIRECTOR:
SMITH, LORNAFACILITY TYPE:
740
ADDRESS:312 GUAVA PLACETELEPHONE:
(714) 332-0685
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY: 6CENSUS: 4DATE:
01/17/2025
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Lorna Smith, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to the facility today to conduct a Case Management Visit. LPA was greeted and granted entry by Lorna Smith, Administrator (AD) and explained the purpose of the visit.

The facility is a five bedroom, three bathroom, single story home with an approved fire clearance of six non-ambulatory residents of which six may be on hospice. The facility currently has a census of four residents in care.

LPA and AD toured the facility and did a health and safety check on the residents in care. Two residents were asleep in their respective bedrooms and two residents were seated in the living room area chatting and relaxing with each other. One resident was visiting from the home across the street, Senior's Retreat of Brea, Inc. #306006253; since solar panels were being installed at the time of LPA's visit. The visiting resident and one staff member return to the other facility at the end of the day. All residents were properly cared for.

Based on the observations made during today’s visit, the facility appears to be in compliance with Title 22 Division 6 of the California Code of Regulations, no deficiencies cited on this date. An exit interview was conducted with Lorna Smith, Administrator and a copy of the report was given at the time of the visit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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