306002559-3-20-2025-22-AS-JALE-DEXQFF-20250320120753

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306002559
Report Date: 03/20/2025
Date Signed: 03/20/2025 12:08:11 PM

Document Has Been Signed on 03/20/2025 12:08 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:	LAGUNA PALMS II		FACILITY NUMBER:	306002559
ADMINISTRATOR/ DIRECTOR:	MICHAEL G. MILO		FACILITY TYPE:	740
ADDRESS:	29501 VIA SAN SEBASTIAN		TELEPHONE:	(949) 429-6397
CITY:	LAGUNA NIGUEL	STATE: CA	ZIP CODE:	92677
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 4	DATE:	03/20/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Julieta Milo		TIME VISIT/ INSPECTION COMPLETED:	12:15 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	Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Administrator Julieta Milo explained the reason for the visit. Her Administrator's certificate expires on July 3, 2025. Michael Milo's Administrator's certificate expires on September 6, 2025. Facility is a one story home with 8 bedrooms, living room, 7 bathrooms, kitchen, dining room and a two car garage that is kept locked and used for storage. Facility is licensed for 6 non-ambulatory residents. LPA and Administrator Julieta Milo toured the facility. LPA observed the See Something Say Something Sign posted in the entry way of the facility. There is a fountain in the front courtyard. Two rooms are for staff. LPA observed all resident rooms had the required furnishings. LPA observed all bathrooms were clean and operational. Hot water in the bathrooms measured 116.7 degrees Fahrenheit. LPA observed the kitchen is clean and organized. LPA observed the medications are kept locked in a kitchen cabinet. There is a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. Knives are kept locked under the kitchen sink. LPA observed the laundry room is kept locked. The laundry room is used to store cleaning supplies. LPA and Administrator toured the backyard and garage. The garage is kept locked and used to store extra supplies, food and furniture. There is a small fountain in the backyard. The backyard connects to the front yard on the west side of the house. The side walk way on the east side of the house connects to the driveway. LPA observed bicycles, a wood pallet, a hoyer lift and brooms stored on the east side of the house on the walk way. The front yard is fenced and has a gate. There is a sitting area with a table and chairs in the front court yard.. LPA observed all fire extinguishers are fully charged. Carbon monoxide and smoke detectors tested operational. The last fire drill was conducted on December 25, 2024. LPA inspected the first aid kit. The first aid kit had all the required elements. Facility has an internet device (Tablet) for dedicated resident use. LPA reviewed 4 resident files. LPA observed resident 1 (R1) is bedridden according to their most recent physician's report. No discrepancies observed in the resident files. LPA reviewed 2 staff files, LPA observed Staff 1 and 2 only had 18 hours of annual training. Both staff members had CPR training. During the visit residents participated in bingo. LPA consulted with the Administrator concerning reporting requirements.

Sheila Santos	TELEPHONE: (714) 334-2062
Joseph Alejandre	TELEPHONE: 714-705-6018
	DATE: 03/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025

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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: LAGUNA PALMS II	FACILITY NUMBER: 306002559
	VISIT DATE: 03/20/2025

NARRATIVE

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Based on the observations made during today’s visit deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided. An exit interview was conducted and a copy of the report was provided along with citations and appeal rights. Administrator refused to sign the report (LIC 809 & LIC 809Ds).

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph Alejandre	TELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/20/2025 12:08 PM - It Cannot Be Edited

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: LAGUNA PALMS II	FACILITY NUMBER: 306002559
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/20/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

87204(a)

Limitations -Capacity and Ambulatory Status

(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. An exception may be made in the case of catastrophic emergency when the licensing agency may make temporary exceptions to the approved capacity. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above, Facility is licensed for 6 non-ambulatory residents of which none (0) can be bedridden. R1 is bedridden as documented on their physician's report, which poses an immediate health and safety risk to persons in care.
	POC Due Date: 03/21/2025
	Plan of Correction
1 2 3 4	Licensee agrees to issue an eviction notice to R1 or to complete a new application (LIC 200) to the Agency (CCL) requesting a new fire clearance to allow for bedridden residents. Licensee to forward proof of correction to LPA.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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	TELEPHONE: (714) 334-2062
Joseph Alejandre	TELEPHONE: 714-705-6018
	DATE: 03/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 03/20/2025 12:08 PM - It Cannot Be Edited

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: LAGUNA PALMS II	FACILITY NUMBER: 306002559
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/20/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

HSC

1569.625(b)(2)

Other Provisions

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in 2 out of 2 staff members, Staff 1 and Staff 2, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/27/2025
	Plan of Correction
1 2 3 4	Licensees agrees to train Staff 1 (S1) and Staff 2 (S2) to meet the 20 hour requirement of annual training. Licensee to forward proof of correction to LPA.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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	TELEPHONE: (714) 334-2062
Joseph Alejandre	TELEPHONE: 714-705-6018
	DATE: 03/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2025

LIC809 (FAS) - (06/04)

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