306003864-4-12-2022-22-AS-KSGH-CDETLA-20220412144913

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306003864
Report Date: 04/12/2022
Date Signed: 04/12/2022 02:49:23 PM

Document Has Been Signed on 04/12/2022 02:49 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:	LR CARE HOME		FACILITY NUMBER:	306003864
ADMINISTRATOR:	LORNA CONSTANTINO		FACILITY TYPE:	740
ADDRESS:	26751 CARRANZA DRIVE		TELEPHONE:	(949) 305-1961
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 4	DATE:	04/12/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Raul Constantiono		TIME COMPLETED:	03:00 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	Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility in order to conduct a required annual inspection. LPA arrived at facility, was greeted and granted entry by Raul Constantiono, caregiver after explaining the purpose of the visit and being screened for COVID-19 symptoms. Licensee Lorna Constantino was notified by text message and arrived later to assist with the visit. At approximately 2:00pm, LPA accompanied by caregivers Raul Constantiono and Ferie Abellana toured the inside and outside of the facility. There are currently four (4) residents in care, with one (1) resident currently on hospice. The residents are observed to be relaxing in their bedrooms or in the common areas and appears well taken care of. Bedrooms include all necessary components. Bathrooms are equipped with grab bars and slip mats. Facility appears to be clean, sanitary and free of odors in all areas inspected. Sharp instruments are kept in a cabinet secured by a magnetic lock. Cleaning supplies and toxic substances are securely stored under lock in the attached garage. LPA observed the facility has COVID-19 Precautions posters and required department postings. Facility has an adequate supply of PPE. A LIC808 Mitigation Plan has been submitted on 06/16/2021. LPA observed a sufficient supply of food and water. A 30-day supply of medication is centrally stored and locked in a cabinet. LPA toured the outside of the facility. Outdoor furniture is present for the residents' enjoyment in the backyard. The perimeter gate is self-latching and can easily be opened in an evacuation. Staff present is observed to be correctly associated in Guardian. The Administrator's license is up to date and posted in a central location. CONTINUED ON FORM LIC809-C

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: 714-703-2851
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022

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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: LR CARE HOME	FACILITY NUMBER: 306003864
	VISIT DATE: 04/12/2022

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CONTINUED FROM FORM LIC809

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 Advisory is issued in regards to the storage of cleaning supplies and the absence of hand washing signs. This report was reviewed with facility representative and a copy of this report was provided and left at facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: 714-703-2851
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022

LIC809 (FAS) - (06/04)

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