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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000372
Report Date: 09/21/2021
Date Signed: 09/21/2021 03:42:43 PM

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:ATRIA DEL SOLFACILITY NUMBER:
306000372
ADMINISTRATOR:GOODWIN, JEREMIAHFACILITY TYPE:
740
ADDRESS:23792 MARGUERITE PKWYTELEPHONE:
(949) 458-1176
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92692
CAPACITY:120CENSUS: 86DATE:
09/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Irma Arreola and Jeremiah GoodwinTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted and granted entry into the facility by Resident Services Director Irma Arreola and Executive Director Jeremiah Goodwin and explained the reason for the visit. Administrator Goodwin has a current administrator certificate expiring on 07/27/2023.

At 1:00 PM, LPA toured the facility with Administrator and Resident Services Director. Facility has eighty six residents in care during today's visit with 3 residents on hospice care. Facility consists of Assisted Living and Memory Care units. LPA observed residents relaxing in the facility. All residents appeared happy and well taken care of. Facility appears clean and sanitary. All resident rooms had the required elements as well as restrooms stocked with soap/ sanitizer. All rooms observed are single occupancy. Facility screens all visitors to the facility and LPA observed the screening/ sanitizing station in the facility. Facility utilizes a visitor sign in sheet. Facility takes resident and staff temperatures daily and documents. Facility has covid precaution postings as well as department postings. LPA observed the first aid kit has all required items. Facility mitigation plan has been approved. Facility has emergency evacuation chairs at the top of both stairwells. LPA observed an ample supply of emergency food and water. Facility tests smoke detectors monthly and provided documentation of such. LPA toured the outside grounds and observed multiple outside visitation areas. LPA observed the medication room and facility uses electronic medical records for medication management. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation and quarantine. LPA reviewed select resident files during the visit and all files are up to date including emergency information. Most residents and all staff are vaccinated for Covid-19.
LPA consulted with Administrator regarding the size of the "Let Us Know" poster. Facility to enlarge poster to 20" x 26" and re-post in facility.
No deficiencies noted during today's visit. An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
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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