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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306006494
Report Date:
06/19/2024
Date Signed:
06/19/2024 07:58:34 AM
Document Has Been Signed on
06/19/2024 07:58 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:
SIERRA VISTA SENIOR LIVING
FACILITY NUMBER:
306006494
ADMINISTRATOR/
DIRECTOR:
ARIAS, ALEXANDER
FACILITY TYPE:
740
ADDRESS:
1763 S CARNELIAN ST
TELEPHONE:
(832) 386-9747
CITY:
ANAHEIM
STATE:
CA
ZIP CODE:
92802
CAPACITY:
6
CENSUS:
DATE:
06/19/2024
TYPE OF VISIT:
Prelicensing
UNANNOUNCED
TIME VISIT/
INSPECTION BEGAN:
07:10 AM
MET WITH:
Alexander Arias
TIME VISIT/
INSPECTION COMPLETED:
08:20 AM
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Licensing Program Analyst (LPA) Kimberly Lyman made an announced visit to follow upon a pre-licensing inspection. LPA identified herself and discussed the purpose of the visit with Administrator/ Licensee Alexander Arias. An initial application to operate a Residential Care Facility for the Elderly was received by CCL on 01/23/2024 for a capacity of six non-ambulatory residents.
LPA Lyman toured the facility at 7:20 AM and observed the following:
Water temperature measured between 105.2 and 109.4 degrees F.
Facility has a phone available for residents.
LPA observed night light in hallway.
Fireplace has a screen.
Facility has ample emergency water.
The "Let Us No" poster is posted in regulation size.
Room 4 has been reconfigured and has 2 dressers for resident's belongings.
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:
06/19/2024
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
06/19/2024
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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