<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006204
Report Date: 10/25/2022
Date Signed: 10/25/2022 03:09:30 PM

Document Has Been Signed on 10/25/2022 03:09 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:WILLOW VIEW GARDENS MEMORY CARE & ASSISTED LIVINGFACILITY NUMBER:
306006204
ADMINISTRATOR:ESPINAL, ALMAFACILITY TYPE:
740
ADDRESS:2025 N BUSH STTELEPHONE:
(714) 541-3357
CITY:SANTA ANASTATE: CAZIP CODE:
92706
CAPACITY: 130CENSUS: 42DATE:
10/25/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Kristine Juarez and Alma EspinalTIME COMPLETED:
12:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Kimberly Lyman made an announced visit to conduct a pre-licensing inspection. LPA identified herself and discussed the purpose of the visit with Executive Director Alma Espinal and Licensee Kristine Juarez. An initial application to operate a Residential Care Facility for the Elderly was received by CCL on 08/03/2022 for a capacity of eighty non-ambulatory and fifty bedridden residents. Facility has a covid screening area in the entrance of the facility. There are thirty three assisted living residents and nine memory care residents present during the visit.
LPA Lyman along with Executive Director, Licensee and Maintenance Director Tony Ruiz toured the facility at 9:35 AM and observed the following:
Structure: Facility is a two story building with the memory care unit on the second floor. Facility has a library, salon, multiple activity areas, movie theater, computer lab and snack area. Common Areas: Adequate seating is available in both memory care and assisted living areas. Bedrooms Residents: Rooms are single and double occupancy. All rooms are equipped with appropriate lighting, furnishings and ample closet space. Bathrooms: All resident bathrooms have a working toilet/ wash basin as well as grab bars and non-skid surface in the shower. Facility has sanitizer/ soap in the restrooms. Linens & Hygiene Supplies: Facility has ample bedding, towels and hygiene supplies for residents in care. Emergency Phone Numbers and Exit Plan: Posted in entrance of facility. Food Service: Facility has a separate dining area for assisted living and memory care residents as well as an auxiliary snack area. LPA toured the main kitchen. Facility has ample 2 day perishables and 7 day non-perishables. Freezers and refrigerator temperatures are monitored daily and LPA observed documentation. Smoke Detectors: Smoke detectors/ carbon monoxide detectors tested operational during today's visit. Facility self tests smoke detectors monthly and an outside company, Hilltop Alarms, comes in for additional fire testing with last inspection on 01/17/2022. Fire extinguishers are mounted and charged. Appliances: Kitchen appliances as well as washers and dryers are clean and operational. LPA observed two laundry areas with one of the areas for resident to self clean their own laundry as desired. Continued on LIC 809C DATED 10/25/2022.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: WILLOW VIEW GARDENS MEMORY CARE & ASSISTED LIVING
FACILITY NUMBER: 306006204
VISIT DATE: 10/25/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Toxins/ Sharps: Facility has for toxins and sharps secured in locked closets. Water Temperature: Tested and recorded between 105.6 and 117.1 degrees F. in facility bathrooms. Emergency Supplies: LPA observed ample emergency food and water in the facility as well as emergency incontinence supplies. LPA observed ample PPE supply in the facility as well as a generator for emergencies. Medications, First-Aid Kit & Book: Facility has multiple first aid kits which contained required items. Medication is stored and locked in medication carts in medication room. Facility uses a hand written medication administration record. Resident & Staff File: Records are stored in the executive office. Reading Material, Games, and Equipment: LPA observed posted activity schedule with activities such as exercise, games and outings in the community. Outside areas: LPA observed multiple outdoor shaded areas for visiting. Fire Clearance: Approved for eighty non-ambulatory residents and fifty bedridden residents on 08/23/2022. Memory care has alarmed exits.

During the visit, LPA observed the following:
  • Multiple doors in the facility are discolored. Please clean/ repaint doors and forward proof to LPA by 11/01/2022.
  • There are discarded boxes on side of facility. Please dispose of boxes.



Component three waived during visit. Licensee is current owner of additional facilities.
Facility is ready to be licensed.






Exit interview conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2