306002492-5-19-2026-22-AS-WVAS-DU8QFE-20260519120748

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306002492
Report Date: 05/19/2026
Date Signed: 05/19/2026 12:07:56 PM

Document Has Been Signed on 05/19/2026 12:07 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:	ELIZABETH HOMES- LOS MOLINOS		FACILITY NUMBER:	306002492
ADMINISTRATOR/ DIRECTOR:	ELIZABETH SANTOS		FACILITY TYPE:	735
ADDRESS:	5940 LOS MOLINOS DRIVE		TELEPHONE:	(714) 995-1106
CITY:	BUENA PARK	STATE: CA	ZIP CODE:	90620
CAPACITY: 6		CENSUS: 3	DATE:	05/19/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:00 AM
MET WITH:	Maxima Kniazeff (Administrator)		TIME VISIT/ INSPECTION COMPLETED:	12:00 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 today's date Licensing Program Analyst (LPA) William Vanegas conducted an unannounced visit for the purposes of completing an annual inspection. Upon arrival LPA was greeted and granted entry to the facility by care giving staff. LPA explained the purpose of the visit and Administrator (AD) Maxima Kniazeff was notified via telephone and arrived shortly after to assist with annual inspection. LPA began a tour of the facility and observed the following. AD Maxima Kniazeff has a valid Administrator Certificate valid from July 29, 2024 through July 28, 2026. The facility is a one storied home with six bedrooms, three of which are utilized for clients in care, and three of which are utilized for facility storage/office space. The facility is equipped with two bathrooms which are both shared. The facility is equipped with an attached two car garage and a large backyard. LPA observed kitchen area to be clean and free of any debris and mildew, LPA observed kitchen area to have a refrigerator, microwave, and gas stove. All appeared to be in good repair and tested operational. LPA observed a two day supply of perishable food and a seven day supply of non-perishable food on hand. Additionally LPA observed a sufficient amount of emergency water on hand. LPA observed all resident bedrooms to be clean and free of any hazards, and to be large enough to walk about freely. LPA observed all bedrooms to have all required furnishings such as a chest of drawers, a bed, clean linens in good repair; meaning no strains or tears, a reading lamp, and enough storage space to store personal belongings. LPA observed all restrooms to be clean and free of any hazards, mildew, and debris. LPA observed all water faucets and toilets to be operational. LPA observed all required furnishings to be present including grab bars, slip resistant floor matts, and a shower chair if needed. Hot water temperature tested between 109.1 and 111.2 degrees Fahrenheit. CONTINUED ON LIC809-C

NAME OF LICENSING PROGRAM MANAGER: Kevin Saborit-Guasch
NAME OF LICENSING PROGRAM ANALYST: William Vanegas
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026

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 3

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)

Page: 2 of 3

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: ELIZABETH HOMES- LOS MOLINOS	FACILITY NUMBER: 306002492
	VISIT DATE: 05/19/2026

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
26
27
28
29
30
31
32

LPA observed all smoke detectors and carbon monoxide detectors to be in good repair and tested operational. LPA observed all fire extinguishers to be fully charged, and to have an updated service tag attached to it. LPA observed first aid kit to have all required items in it including adhesive tape, scissors, tweezers, bandages, a thermometer, and a first aid manual.

LPA conducted a tour of the outside of the facility and observed the following. The backyard is clean and free of any hazards or debris along the outside of the facility. LPA observed the backyard to be large enough to participate in outdoor activities upon client request. LPA observed there to be an outdoor shaded sitting area and for the outside side doors to be unlocked and self latching.

LPA reviewed three client files and two staff files, all files (staff and client) had all required documents and had all staff annual training documented correctly. LPA reviewed medications with AD and observed for all medications to be documented correctly and for the medications to be administered per physicians orders. No discrepancies were noted. LPA reviewed P&I with AD and observed for all balances to be documented correctly and corresponded with cash on hand.

Based on observations made during today's inspection no deficiencies will be issued per title 22 chapter 6 division 8 of the California Code of Regulations. An exit interview was conducted with AD and a copy of this report was provided to the facility. Additionally a copy of this report will be mailed to the licensee.

NAME OF LICENSING PROGRAM MANAGER: Kevin Saborit-Guasch
NAME OF LICENSING PROGRAM ANALYST: William Vanegas
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2026

LIC809 (FAS) - (06/04)

Page: 3 of 3