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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002429
Report Date: 09/10/2026
Date Signed: 09/10/2026 03:52:55 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/10/2026 03:52 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:FAMILY CARE - PEPITA HOMEFACILITY NUMBER:
306002429
ADMINISTRATOR/
DIRECTOR:		RUSSELL VENANZIFACILITY TYPE:
740
ADDRESS:26741 PEPITA DRIVETELEPHONE:
(949) 589-0145
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 5DATE:
09/10/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Ginger Venanzi, Russell VenanziTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Licensee Ginger Venanzi and Russell Venanzi. LPA explained the reason for the visit. Russell Venanzi's Administrator's certificate expires on September 5, 2027. Facility is licensed for 6 non-ambulatory residents of which one can be bedridden with a hospice waiver for 4. Facility is a single story home with 5 bedrooms, 1 is for staff, 2 bathrooms, living room, family room, dining room, kitchen and a two car garage. LPA and Licensee toured the facility. LPA observed the See Something, Say Something poster (PUB 475) posted in the main entry of the facility. LPA observed the Facility License posted in the family room of the facility. LPA did not observe, Resident Rights and Rights of Resident Councils posted in the facility. The last emergency drill was conducted on August 20, 2026. Smoke detectors/carbon monoxide detectors tested operational. LPA observed the fire extinguisher in the dining room is fully charged. LPA observed the fireplace in the family room does not have a screen. Licensee reported that the fireplace is never used. The fireplace is gas fireplace and staff reported the key to open the gas line is kept locked. LPA observed all resident rooms have the required furnishings and bed linens. LPA observed both bathrooms are clean and operational. Hot water in bathroom 1 and bathroom 2 measured 105.0 degrees Fahrenheit. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed a 3 day supply of emergency food stored in the kitchen. Knives and sharp objects are kept locked in a ktichen drawer. Cleaning supplies are kept locked under the kitchen sink. LPA and Licensee toured the garage. LPA observed a 3 day emergency water supply in the garage. The garage is used to store supplies and old furniture. The garage is kept locked and inaccessible to residents. LPA observed there is a room in the garage being used as a bedroom. LPA toured the backyard. No bodies of water observed. There is an open shed with planters and plants inside. There is a table with an umbrella and chairs to sit out side. There is a pigeon coupe with 12 doves in it. The doves and pigeon coupe pose no danger to residents in care.
Sheila Santos
Joseph Alejandre
DATE: 09/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 09/10/2026 03:52 PM - It Cannot Be Edited


Created By: Joseph Alejandre On 09/10/2026 at 01:45 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: FAMILY CARE - PEPITA HOME
FACILITY NUMBER: 306002429

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/11/2026
Section Cited
CCR
87355(e)(3)

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(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c)...
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Licensee agrees to have Staff 1 and Staff 2 associated to the facility prior to their return to work at the facility. Licensee to submit proof of association to the LPA.
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This requirement was not met as evidenced by, a review of records shows Staff 1 and Staff 2 have background clearances but are not associated to the facility, this poses an immediate health and safety risk to residents in care.
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Type A
09/11/2026
Section Cited
CCR87307(a)(2)(B)

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(B) No room commonly used for other purposes shall be used as a sleeping room for any resident. This includes any hall, stairway, unfinished attic, garage storage area, shed or similar detached building.
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Licensee agrees to take down the room in the garage and to remove the personal belongings from the room. Licensee agrees not to use the garage as a bedroom for any residents including staff.
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This requirement is not being met as evidenced by LPA observed there is a room in the garage set up as a bedroom with personal belongings inside. This poses an immediate, health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Sheila Santos
NAME OF LICENSING PROGRAM MANAGER:
Joseph Alejandre
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2026


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: FAMILY CARE - PEPITA HOME
FACILITY NUMBER: 306002429
VISIT DATE: 09/10/2026
NARRATIVE
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The exit gate on the West side of the house is operational. No obstacles or hazards observed inside or outside of the house. LPA observed 2 out of 3 staff present are background cleared but not associated to the facility. Staff 1 and Staff 2 are not associated to the facility. LPA observed Staff 1 and Staff 2 leave the facility. Staff 3 is background cleared and associated to the facility. All 3 staff have CPR/First Aid training. Staff 3 has the required 20 hours of annual training. LPA reviewed 5 staff files and medications, no discrepancies observed.

Deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report provided along with appeal rights.
NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Joseph Alejandre
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2026
LIC809 (FAS) - (06/04)
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