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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002025
Report Date: 10/05/2021
Date Signed: 10/05/2021 10:25:19 AM

Document Has Been Signed on 10/05/2021 10:25 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:LONIKA HOME IIFACILITY NUMBER:
306002025
ADMINISTRATOR:DEL ROSARIO, ELEANORFACILITY TYPE:
735
ADDRESS:24922 MOSQUERO ST.TELEPHONE:
(949) 305-0087
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 4DATE:
10/05/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Luzma Duco, Live in Direct Care StaffTIME COMPLETED:
10:24 AM
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On today’s date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA Quiroz was greeted and granted entry into the facility by Live in Direct Care Staff (DCS) Luzma Duco and explained the nature of the visit. Administrator Lori Cook arrived shortly after. This facility is licensed to provide services to 6 Ambulatory Clients. Facility is a level 2 home providing services to clients developmentally disabled ages 18 to 59 years old.

Administrator (AD) Lori Cook has an Administrator Certificate with expiration date of 11/20/2021.

On or about 9:11am LPA Quiroz along with DCS Duco toured the inside and outside of facility. Staff working at facility was observed to be wearing face masks upon arrival to facility. There are four clients in care and there are no active COVID-19 cases. During today's inspection visit, there were no clients present at the facility. Administrator indicated "All clients are at day program. They all return between 1:30pm-5:00pm."

LPA Quiroz observed required department postings in the facility as well as hand washing signs in the restrooms. All restrooms observed to have ample soap/sanitizer and appeared clean. LPA Quiroz inspected clients’ bedrooms and appeared clean and sanitary. All bedrooms observed to have all required components. LPA Quiroz observed a check in station in the main entry of the facility. Facility is taking temperatures daily and documenting results. LPA Quiroz observed the emergency disaster and evacuation plan. Facility has back-up emergency food and water supply as well as PPE supplies. LPA Quiroz toured the outside of the facility and observed seating area with table and chairs for client’s enjoyment in the front porch and back yard area. Facility has completed the LIC 808 Mitigation plan dated 3/1/2021, which was approved on today's date.

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SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE: DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2021
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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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: LONIKA HOME II
FACILITY NUMBER: 306002025
VISIT DATE: 10/05/2021
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During today's inspection visit, LPA Quiroz reviewed four of four client records.

Based on the observation made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with Administrator Lori Cook during today's visit, and a copy of this report was provided to Administrator Lori Cook at exit.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021
LIC809 (FAS) - (06/04)
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