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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306003905
Report Date:
09/16/2021
Date Signed:
09/16/2021 12:33:49 PM
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:
AEGIS ASSISTED LIVING OF LAGUNA NIGUEL
FACILITY NUMBER:
306003905
ADMINISTRATOR:
ERIC MEDOR
FACILITY TYPE:
740
ADDRESS:
32170 NIGUEL ROAD
TELEPHONE:
(949) 496-8080
CITY:
LAGUNA NIGUEL
STATE:
CA
ZIP CODE:
92677
CAPACITY:
96
CENSUS:
68
DATE:
09/16/2021
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
11:07 AM
MET WITH:
Joe Daldrup
TIME COMPLETED:
12:50 PM
NARRATIVE
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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 was screened before entry. LPA met with General Manager (GM) Joe Daldrup. LPA explained the reason for the visit. LPA and GM toured the facility. Facility is a two story building with memory care on the first floor. LPA toured the memory care unit with the GM. LPA and GM toured the kitchen and dining room. LPA observed all staff wearing masks. LPA observed hand sanitizing stations. LPA and GM toured the second floor of the facility. LPA reviewed the inspection tool and the mitigation plan with the General Manager. LPA reviewed the Guardian system with the General Manager. Facility Mitigation plan was approved on 2/9/2021. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of this report provided.
SUPERVISOR'S NAME:
Luz Adams
TELEPHONE:
(714) 703-2855
LICENSING EVALUATOR NAME:
Joseph Alejandre
TELEPHONE:
(951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE:
09/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/16/2021
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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