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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002025
Report Date: 09/13/2024
Date Signed: 09/13/2024 12:42:50 PM

Document Has Been Signed on 09/13/2024 12:42 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:LONIKA HOME IIFACILITY NUMBER:
306002025
ADMINISTRATOR/
DIRECTOR:		DEL ROSARIO, ELEANORFACILITY TYPE:
735
ADDRESS:24922 MOSQUERO ST.TELEPHONE:
(949) 305-0087
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 4DATE:
09/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Eleta Perez, caregiverTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of conducting the Required Annual Inspection. LPA was greeted and granted entry by facility staff after introducing himself and stating the reason of the visit. Administrator Lori Distor was notified via telephone but could not assist with the visit in person.

During the inspection, LPA and staff conducted a tour of the physical plant and observed the following: The facility is a one-story home with one shared and two private bedrooms in addition to the facility's common living areas. There is one shared bathroom, which was observed to be equipped with grab bars and slip mats. All resident bedrooms have the required furnishings. LPA observed all beds have linen and blankets. No postural support in use.

There are currently four clients admitted to the facility, all of which are ambulatory. Bathrooms faucets and toilets are operational. Water temperature was verified to be within acceptable range. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. The most up-to-date form LIC610E is however not in use at this time. Consultation provided. Fire and emergency drills are conducted and documentd. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food. Fridge and freezer temperatures verified. Smoke and carbon monoxide detectors tested operational. Fire extinguisher present is fully charged with up-to-date maintenance tag.

There is adequately shaded outside space with outdoor furniture present. There is a self-latching gate on one side. The route of egress is free of obstructions. There are no bodies of water on the premises.

Medication, cleaning products and sharp items are confirmed to be inaccessible throughout the physical plant. The medication central storage in a cart was also observed to be secure and reviewed to be accurate and up to date with the clients prescription orders. CONTINUED ON FORM LIC809-C
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 7
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: LONIKA HOME II
FACILITY NUMBER: 306002025
VISIT DATE: 09/13/2024
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CONTINUED FROM FORM LIC809
The clients' Personal and Incidental ledgers and funds were reviewed and confirmed to be accurate. Relevant receipts are archived.

LPA reviewed four client files and three staff files. Client records include all necessary components. All staff members are confirmed to be cleared and associated with this particular licensed location. Current CPR training and Direct Service Professional training on file as well. All four clients are away at program during the duration of the visit.

Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Two Technical Violation and Three Technical Assistance advisory notes are provided with a consultation on the required Infection Control Plan, HIV/TB training Emergency and Disaster Plan.

An exit interview was conducted, and a copy of this report was left at the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 09/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2024
LIC809 (FAS) - (06/04)
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