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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006440
Report Date: 02/26/2024
Date Signed: 02/26/2024 11:35:29 AM

Document Has Been Signed on 02/26/2024 11:35 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ARIA SENIOR CARE ASSISTED LIVING LLCFACILITY NUMBER:
306006440
ADMINISTRATOR:YOO, YUMIFACILITY TYPE:
740
ADDRESS:908 N VALLEY VIEW PLTELEPHONE:
(562) 355-4288
CITY:FULLERTONSTATE: CAZIP CODE:
92833
CAPACITY: 6CENSUS: 0DATE:
02/26/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Yumi YooTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an announced visit to the facility for purpose of a pre-licensing evaluation. LPA arrived at the facility was greeted and granted entry by Yumi Yoo, Applicant/Director.

A initial to operate an Adult Residential Facility for the Elderly, age 60 years and over, for (6) capacity, (0) ambulatory, (6) non-ambulatory, and (0) bedridden residents was submitted to CCL on 10/19/2023.

Structure:
The facility is a one story house with an attached garage with 4 resident bedrooms, 2 full bathrooms, a living room, and a dining room/kitchen. The resident’s bedrooms are spacious and will easily accommodate the resident’s furnishings. There is a large back yard with an exit walkway on both sides of the house with seating for the residents. Air/Heating: Central air/heating system installed with a central panel to control entire house. Bedrooms Residents: Bedrooms will accommodate 6 residents with 2 private rooms and 2 shared rooms accommodating two residents. Bedrooms #1 has a full bathroom. Bedrooms Staff: No designated bedroom for awake staff. Bathrooms: All bathrooms have a working toilet, wash basin, walk in shower. Linens & Hygiene Supplies: Adequate supply of linen stored in storage. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menus posted and available. Menus prepared one week prior and listed for food serve for one week. Food Service: Adequate supply of 7-day non-perishable and 2-day perishables are stored in the kitchen. Smoke Detectors: Smoke detectors and carbon monoxide alert systems are hardwired, tested, and found operational. Appliances: Gas five-burner stove, single oven, 1 refrigerator, microwave, toaster oven, washer, and dryer are clean and noted to be operational.

Continued on LIC809-C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2024
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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ARIA SENIOR CARE ASSISTED LIVING LLC
FACILITY NUMBER: 306006440
VISIT DATE: 02/26/2024
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Toxins: All and any toxic chemicals, cleaning solutions and disinfectants are inaccessible to residents and are stored and locked underneath kitchen sink and in closet storage. Water Temperature: Tested and recorded maintained at a comfortable temperature and the water temperature measures 109.4 Fahrenheit degrees in facility bathrooms. Medications, First-Aid Kit & Book: Medication and first aid kit/book are stored and locked in a storage closet by the main entrance of facility. Resident & Staff Files: Records will be kept locked in the medication closet. Reading Material, Games, Equipment & Materials: The facility has board games, books, and other recreational materials for the residents use, commensurate with the plan of operation. Fire clearance: Was approved on 11/08/2023. Component III: Conducted at the Pre-Licensing visit, information provided about how to operate the facility within substantial compliance.

The applicant has met all pre-licensing requirements. LPA will submit notification to CAB in Sacramento for final review prior to license being issued.

Exit interview was conducted and a copy of this report was left with the applicant.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024
LIC809 (FAS) - (06/04)
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