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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006110
Report Date: 03/24/2022
Date Signed: 03/24/2022 10:27:58 AM

Document Has Been Signed on 03/24/2022 10:27 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SELECT SENIOR CARE IIFACILITY NUMBER:
306006110
ADMINISTRATOR:DATCU, DANIELFACILITY TYPE:
740
ADDRESS:16412 MARK LANETELEPHONE:
(909) 358-1209
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY: 6CENSUS: 6DATE:
03/24/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:03 AM
MET WITH:Administrator, Daniel DatcuTIME COMPLETED:
10:35 AM
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Licensing Program Analyst (LPA) Jenifer Tirre made an announced pre-licensing visit to follow up on corrections identified during visit on 03/16/2022. LPA identified themselves and discussed the purpose of the visit with Licensee/ Administrator Daniel Datcu. An initial application to operate a Residential Facility Care for the Elderly was submitted to CCL on 11/24/2021. There are 6 residents in care during today's visit. LPA observed facility is following covid precaution guidelines.

At 10:15 AM LPA toured the facility and observed the following:

· Water temperature measured between 110.6 and 120.0 degrees F. in facility restrooms

· Facility obtained First Aid Manual for First Aid Kit

All noted items from visit on 03/16//2022 have been addressed.


The facility is ready to be licensed.

An exit interview was conducted with Licensee and a copy of this report was left at the facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2022
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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