<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003557
Report Date: 08/15/2022
Date Signed: 08/15/2022 01:22:23 PM


Document Has Been Signed on 08/15/2022 01:22 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:LOTUS SENIOR CAREFACILITY NUMBER:
306003557
ADMINISTRATOR:RITA LEEFACILITY TYPE:
740
ADDRESS:25422 MARINA CIRCLETELEPHONE:
(949) 636-8007
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 4DATE:
08/15/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Belinda Rilengado, caregiverTIME COMPLETED:
01:35 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 08/15/2022 at 11:45am, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility in order to follow up on the plan of corrections issued during the annual inspection on 08/01/2022. LPA was greeted and granted entry by caregiving staff after explaining the purpose of the visit. Administrator Rita Lee could not be physically present to assist with the visit but was notified and kept informed of the report's findings over the phone.

At approximately 12:10pm, LPA accompanied by caregiver Belinda Rilengado inspected both perimeter gates. The carabiniers that had been removed during the annual inspection are observed to be back into place on both gates. Caregiver Belinda Rilengado states that the night staff uses these to lock the gates at night and that the day staff has forgotten to remove them. Deterrents were put in place following an instance of an individual not associated with the facility coming into the backyard through the side gate and knocking on the window leading to the caregiver's room. Given that the deterrent mechanism does not require a key or additional tool, LPA reminds staff that the mechanism should only be put into place in the evening and at night but not during the day.

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. A Technical Violation is however issued as a reminder to the licensee to adhere with the terms of their current fire clearance. This report was reviewed with facility representative and a copy of this report was provided and left at facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: 714-703-2851
LICENSING EVALUATOR SIGNATURE:
DATE: 08/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2022
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 1