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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003905
Report Date: 09/20/2024
Date Signed: 09/20/2024 04:15:01 PM


Document Has Been Signed on 09/20/2024 04:15 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:AEGIS ASSISTED LIVING OF LAGUNA NIGUELFACILITY NUMBER:
306003905
ADMINISTRATOR:KURT KNAUERFACILITY TYPE:
740
ADDRESS:32170 NIGUEL ROADTELEPHONE:
(949) 496-8080
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY:96CENSUS: 63DATE:
09/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Kurt KnauerTIME COMPLETED:
04:30 PM
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Licensing Program Analysts (LPAs) Joseph Alejandre and Rose Rupert made an unannounced visit to conduct the required annual inspection. LPAs were greeted and granted entry by staff. LPAs met with General Manager Kurt Knauer and explained the reason for the visit. LPAs and General Manager toured the facility. The facility has a capacity of 96, 75 non-ambulatory, of which 21 may be bedridden and a hospice waiver for 15. The facility is a two story building with a central courtyard in the center. The facility has one kitchen with multiple dining and activity rooms. All the rooms are private with the their own bathroom. The memory care units are on the first floor, one unit (Golden Lantern) is on the North side of the building and the other unit (Blue Lantern) is on the South side of the building. Both memory care units have delayed egress exits. The LPAs tested the delayed egress exits and they are operational. LPAs observed the See Something Say Something poster (PUB 475) posted in the main entry way of the facility. LPAs observed each stairway had an emergency evacuation chair. All fire extinguishers are fully charged. LPAs inspected seven resident rooms. LPAs observed each resident room inspected was clean and had the required furnishings. Hot water was measured in each room inspected. Hot water measured from 105.9 to 118.9 degrees Fahrenheit. LPAs observed emergency food and water stored in a supply closet. LPAs toured the kitchen and dining room. The kitchen is clean and organized. LPAs observed temperature logs for the refrigerators and freezers posted in the kitchen. The refrigerators and freezer are kept at the required temperatures. LPAs observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. The last fire drill was conducted on August 6, 2024. LPAs observed the medication cart is kept locked in the health and wellness office. LPAs inspected the first aid kit. The first aid kit did not contain a first aid manual. LPAs and the General Manager toured the courtyard. No bodies of water observed. The fountain has been converted into a large planter. There are numerous tables and chairs with umbrellas to sit outside. During the visit LPAs observed residents playing bingo in the activity room and LPAs observed a sing a long in the activity room. The fireplaces in the library and the downstairs parlor are screened. No obstacles or hazards observed inside or outside of the facility. LPAs reviewed 7 resident files, no discrepancies observed. LPAs reviewed 5 staff files, no discrepancies observed.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2024
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: AEGIS ASSISTED LIVING OF LAGUNA NIGUEL
FACILITY NUMBER: 306003905
VISIT DATE: 09/20/2024
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Staff files reviewed had the required training including CPR/First aid. LPAs interviewed staff and residents. All staff interviewed and files that were reviewed are background cleared and associated to the facility. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:

DATE: 09/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2024
LIC809 (FAS) - (06/04)
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