306000377-8-9-2024-22-AS-AROS-D7YP3B-20240809105715

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306000377
Report Date: 08/09/2024
Date Signed: 08/09/2024 10:57:21 AM

Document Has Been Signed on 08/09/2024 10:57 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:	TENDER LEISURE CARE		FACILITY NUMBER:	306000377
ADMINISTRATOR:	STEPHEN G. VENANZI		FACILITY TYPE:	740
ADDRESS:	25532 ALTHEA		TELEPHONE:	(949) 243-9214
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 5	DATE:	08/09/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Licensee Stephen Venanzi		TIME COMPLETED:	11:00 AM

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Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was greeted and allowed entry into the facility by care giver Romuald Adona to whom LPA discussed the purpose of the visit..Administrator Stephen Venanzi Jr. and Licensee/Administrator Stephen Venanzi later join the visit.

According to the facility’s license, the facility has a maximum capacity of six (6) non-ambulatory clients with a hospice waiver for 3.

LPA, accompanied by care giver and administrator Stephen Venanzi Jr. toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was compliant. Hot water temperature at taps accessible to clients were all compliant.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to clients. Centrally stored medications were properly stored and locked in medication cabinet. Medication logs and medications reviewed were current and medications appear to be administered according to the label instructions.

[continued on 809-C]

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024

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: TENDER LEISURE CARE	FACILITY NUMBER: 306000377
	VISIT DATE: 08/09/2024

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[Continued form 809]

No pools or bodies of water on the premises. Per Licensee/Administrator Venanzi, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit were complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA interviewed staff members and reviewed the staff records/files. LPA interviews did not raise any licensing concerns. LPA interviews with clients did not raise any licensing concerns.

Staff records review verified that all staff records are complete and compliant. All direct care staff have First Aide/CPR certificates, and staff training. Resident records reviewed and confirmed compliant. Administrator’s certification is current.

LPA reviewed the theft and loss policy and procedures. Transportation procedures are compliant. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs

An exit interview was conducted with Licensee/ Administrator Stephen Venanzi , to whom copies of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 08/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024

LIC809 (FAS) - (06/04)

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