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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002025
Report Date: 08/02/2022
Date Signed: 08/02/2022 11:06:08 AM

Document Has Been Signed on 08/02/2022 11:06 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:
08/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Luzma Duco, caregiverTIME COMPLETED:
11:30 AM
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On 08/02/2022 at 9:45am, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility in order to conduct a required annual inspection. LPA rang the bell and knocked at the door but no one answered. LPA called Lori Cook, Administrator at (949) 510-5342 to inform her of the attempted annual. Administrator indicated she would get in touch with caregiver Luzma Duco, present on the premises in the backyard who then greeted and granted entry to LPA after being explained the purpose of the visit.

At approximately 10:10am, LPA accompanied by caregiver toured the physical plant of the facility. LPA observed a check-in station where visitor temperatures are being documented. There are currently four (4) clients in care. All clients are currently away at their respective day program and will be coming back to the facility around 2pm. The three (3) shared bedrooms include all necessary components. The shared bathroom is equipped with grab bars and slip mats. Facility is clean, sanitary and free of odors in all areas inspected.

Sharp instruments are stored in a locked kitchen drawer. LPA observed a sufficient supply of food and water as well as emergency water and rations present. A 30-day supply of medication is centrally stored in a locked cart in the dining room. Cleaning supplies are located in the laundry room and in a locked cabinet under the kitchen sink. LPA observed the facility has COVID-19 Precautions posters and all required department postings as well as hand-washing signs in the bathrooms. Facility has an adequate supply of PPE. A fire extinguisher is present and charged.

CONTINUED ON FORM LIC809-C
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2022
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: LONIKA HOME II
FACILITY NUMBER: 306002025
VISIT DATE: 08/02/2022
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CONTINUED FROM FORM LIC809

Staff present is correctly cleared and associated in Guardian. LPA toured the outside of the facility and observed it to be free of obstructions. Outdoor furniture is present for the clients' enjoyment. The perimeter gate is self-latching and can easily be opened in an evacuation. There are no bodies of water are present 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.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022
LIC809 (FAS) - (06/04)
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