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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300606831
Report Date: 07/26/2024
Date Signed: 07/26/2024 03:53:49 PM


Document Has Been Signed on 07/26/2024 03:53 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:FREEDOM VILLAGEFACILITY NUMBER:
300606831
ADMINISTRATOR:MARIANNE CASINO/ J.NIBLETTFACILITY TYPE:
741
ADDRESS:23442 EL TORO ROADTELEPHONE:
(949) 472-4733
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:533CENSUS: 317DATE:
07/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Hrag Bekerian-Administrator, Jean Guevara-Director of Nursing, Marybeth Melby-Assistant Director of Nursing TIME COMPLETED:
04:08 PM
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit for the Required 1 Year Inspection. LPA explained the purpose of today’s visit, and was greeted and granted entry by Director of Nursing Jean Guevara. Administrator (AD) Hrag Bekerian arrived shortly after.

LPA observed the Administrator's Certificate for facility AD Hrag Bekerian which expires on January 12, 2025.

LPA Ramirez toured the interior and exterior portions of the facility with Guevara and AD Bekerian. The facility is a three level building with Skill Nursing on the first floor and Assisted Living on the second and third floors. The facility is licensed for 300 ambulatory and 233 non-ambulatory residents, of which five may be on hospice. Facility has 57 residents in care during today's visit. Facility has a library, beauty salon, and multiple visitation areas.

During today's visit LPA observed the residents participating in activities such as social coffee time and bingo. LPA also observed residents in the beauty salon, watching television in their bedroom and/or relaxing in the common areas.

LPA Ramirez toured the bedrooms in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Fire extinguishers were charged and mounted throughout the hallways. Quick Response Fire Protection conducted a fire inspection on July 15th, 2024 and facility tests smoke detectors in-house monthly. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature tested between 105.2-111.3 degrees Fahrenheit.

Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care.

CONTINUED ON LIC809-C..

SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-705-6007
LICENSING EVALUATOR SIGNATURE:
DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/26/2024
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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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: FREEDOM VILLAGE
FACILITY NUMBER: 300606831
VISIT DATE: 07/26/2024
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LPA Ramirez observed the emergency disaster and evacuation plan, which is located by main entrance. Facility had back-up emergency food and water supply. LPA observed that First Aid Kit had all the required components. LPA observed that medications and toxins were locked and inaccessible to residents in care.

For the exterior portion, LPA Ramirez observed a shaded area, patio furniture, and the grounds were free of any hazards. No bodies of water were observed.

LPA reviewed seven resident files and seven staff files. LPA interviewed residents and staff present.

For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with AD Bekerian.

A copy of this report was provided at the time of exit.

SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-705-6007
LICENSING EVALUATOR SIGNATURE:

DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2024
LIC809 (FAS) - (06/04)
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