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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006109
Report Date: 03/12/2025
Date Signed: 03/12/2025 03:16:18 PM

Document Has Been Signed on 03/12/2025 03:16 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:GOLDEN LIFE MANOR IFACILITY NUMBER:
306006109
ADMINISTRATOR/
DIRECTOR:		NUNEZ, LORENZIFACILITY TYPE:
740
ADDRESS:2315 E. PURITAN LANETELEPHONE:
(562) 544-9167
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY: 5CENSUS: 5DATE:
03/12/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Administrator- Lorenzi NunezTIME VISIT/
INSPECTION COMPLETED:
09:59 AM
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On March 12, 2025, at 8:00 AM Licensing Program Analyst (LPA) Edward Kim conducted a case management visit to follow up a request to increase capacity from five (5) nonambulatory facility to a six (6) nonambulatory facility. LPA Kim was greeted and granted entry to the facility by Caregiver (CG) Cezar Acevedo. Administrator (AD) Lorenzi Nunez arrived at the facility at 8:25 AM and LPA Kim explained the purpose of the visit.

LPA Kim toured the indoor and outdoor of the physical facility with AD Nunez. LPA Kim observed and took photos of Room 1 where the facility is requesting to change the room capacity from one (1) nonambulatory to two (2) nonambulatory.

An exit interview was conducted and a copy of this repot was provided to Administrator Lorenzi Nunez.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Edward Kim
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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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