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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306003905
Report Date:
08/10/2022
Date Signed:
08/10/2022 02:37:31 PM
Document Has Been Signed on
08/10/2022 02:37 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:
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:
62
DATE:
08/10/2022
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
12:30 PM
MET WITH:
Al Otieno
TIME COMPLETED:
02:55 PM
NARRATIVE
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was screened for symptoms of Covid-19 and granted entry. LPA met with Executive Director (ED) Al Otieno and explained the reason for the visit. LPA and ED toured the facility. The building is a two story building with two separate sections on each end of the building for memory care. The memory care areas have delayed egress exits that are operational. There is a courtyard in the center with a patio and seating. There is a fountain in the courtyard that is used as a planter. There is no water in the fountain. LPA observed all fire extinguishers are fully charged. LPA observed an emergency chair lift in each stairwell. LPA observed the medication is kept locked in a medication cart. LPA observed the kitchen and dining room are clean and organized. Facility has a seven day non-perishable and a two day perishable food supply on hand along with an emergency food and water supply. LPA observed the facility has a 30 day supply of PPE on hand. LPA observed all staff were wearing masks. No obstacles or hazards were observed inside or outside of the facility. LPA consulted with the Executive Director concerning reporting requirements and continued Covid-19 mitigation. No deficiencies observed during the visit. No deficiencies are being cited. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME:
Luz Adams
TELEPHONE:
(714) 703-2855
LICENSING EVALUATOR NAME:
Joseph Alejandre
TELEPHONE:
(951) 473-7041
LICENSING EVALUATOR SIGNATURE:
DATE:
08/10/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/10/2022
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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