306001585-9-6-2022-22-AS-KSGH-CHZRL4-20220906130631

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306001585
Report Date: 09/06/2022
Date Signed: 09/06/2022 01:06:50 PM

Document Has Been Signed on 09/06/2022 01:06 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	LAKEVIEW HOMES MISSION VIEJO		FACILITY NUMBER:	306001585
ADMINISTRATOR:	ALFONSO VENTURA		FACILITY TYPE:	740
ADDRESS:	23036 SONOITA		TELEPHONE:	(949) 583-1213
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	4	CENSUS: 4	DATE:	09/06/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Sarah Fresco, house manager Albert Yusikee, caregiver Anastacia Plandes, caregiver		TIME COMPLETED:	01:25 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 09/06/2022 at 11:15am, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility in order to conduct a required annual inspection focusing on Infection Control procedures. LPA was greeted and granted entry by caregiving staff and explained the purpose of the visit. House Manager Sarah Fresco was notified by telephone and arrived later to assist with the visit. Administrator Peter Ventura was also notified of the ongoing visit. At approximately 11:35am, LPA accompanied by caregiver toured the physical plant of the facility. There are currently four (4) residents in care, none of which are receiving hospice care. One resident's bed is observed to be equipped with half rails. LPA requested the required physician order for postural supports which was provided by the facility during the visit. Residents are observed relaxing in the common areas or in their respective bedrooms and appear clean and well taken care of. The bedrooms include all necessary components. Bathrooms are equipped with grab bars and slip mats. Facility is clean, sanitary and free of odors in all areas inspected. Sharp instruments and cleaning supplies are stored under the sink in a cabinet secured by a magnetic lock. The centrally stored medication is located in the kitchen in a magnetically locked cabinet. A laundry area along with detergent are observed in the locked attached garage. LPA observed a sufficient supply of food and water present. LPA observed the facility has COVID-19 Precautions posters and all required department postings. Staff present is adequately cleared and associated in Guardian. The fire extinguisher present is mounted and charged. Service dates are up-to-date. The posted administrator certificate is shown to be out-of-date, however facility manager was able to provide documentation of the required coursework and valid certification during the visit. LPA provides consultation on the necessity to replace the posted document with a valid copy. CONTINUED ON FORM LIC809-C

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: 714-703-2851
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022

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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: LAKEVIEW HOMES MISSION VIEJO	FACILITY NUMBER: 306001585
	VISIT DATE: 09/06/2022

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CONTINUED FROM FORM LIC809

LPA and caregivertoured the outside of the facility and observed it to be free of obstructions. Outdoor furniture and a shaded area are present for the enjoyment of residents and visitors. The perimeter gates on both sides of the facility are self-latching and can easily be opened in an evacuation. There are no bodies of water on the premises.

Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with facility representative and a copy of this report was provided and left at facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: 714-703-2851
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2022

LIC809 (FAS) - (06/04)

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