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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003937
Report Date: 01/31/2024
Date Signed: 01/31/2024 01:16:30 PM


Document Has Been Signed on 01/31/2024 01:16 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:LOS TIEMPOS SENIOR LIVINGFACILITY NUMBER:
306003937
ADMINISTRATOR:ROSA FIGUEROAFACILITY TYPE:
740
ADDRESS:17935 LOS TIEMPOS STREETTELEPHONE:
(714) 964-6310
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:6CENSUS: 6DATE:
01/31/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Rosa Figueroa, Licensee/Administrator and Lesly Figueroa, Licensee RepresentativeTIME COMPLETED:
01:15 PM
NARRATIVE
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At this Informal Meeting the following were in attendance: Marina Stanic Regional Manager (Orange),Alisa Ortiz, Licensing Program Manager, Lourdes Montoya, Licensing Program Manager, Rosie Quiroz, Licensing Program Analyst, Rosa Figueroa, Licensee/Administrator and Lesly Figueroa, Licensee Representative.

This Informal meeting was called to discuss the following issues or deficiencies:
The purpose of this Informal Meeting is to address with the Licensee, CCLD's concerns regarding the on going non-compliance of the Licensee’s facility Los Tiempos Senior Living (#306003937), Los Tiempos Senior Living #2 (#306006194) and Los Tiempos Senior Living #3 (#306004791).
The applicable regulations are contained within the Title 22 Finances.

The meeting process was explained to the Licensee.
· On 10/9/2023, the Department initiated a solvency audit investigation against the facility after the Regional Office received a complaint.

The Department’s investigation determined as follows:
· The licensee is generating sufficient income to meet the operating cost. However, there is not a sufficient fund reserve in the business checking account to cover any unforeseen expenses.
· The licensee does not have an adequate financial plan.
· The licensee failed to carry liability insurance while operating during January 2023- June 25, 2023.
· The licensee failed to submit documentation requested for audit review.
Licensee agreed to do the following in order to bring the facility into compliance no later than the following dates:

CONTINUED ON LIC 809-C PAGE...
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2024
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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: LOS TIEMPOS SENIOR LIVING
FACILITY NUMBER: 306003937
VISIT DATE: 01/31/2024
NARRATIVE
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CONTINUED...
1) Licensee confirmed that a Certified Administrator will be working at facility at minimum of 20 hours each week.
2) Additional visits will be conducted for the period of one year to expire on 1/31/2025.
3) Licensee is to prepare and submit quarterly profit and loss statement with supporting documents such as monthly utility bills, lease payments and loan agreements to department audit section. First quarterly documents are to be submitted by end of first quarter 4/30/2024. The second quarterly documents are to be submitted by 7/31/2023. The third quarterly documents are to be submitted by 10/31/2024 and the fourth quarterly documents are to be submitted by 1/31/2025.

Licensee has been advised that failure to complete the above agreed upon actions by the dates will result in this Department taking possible administrative actions.

An exit interview was conducted with Licensee/Administrator Rosa Figueroa and Licensee Representative Lesly Figueroa. A copy of this report along with Appeal right and LIC 809-D were provided to the Licensee at the time of the meeting.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/31/2024 01:16 PM - It Cannot Be Edited

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: LOS TIEMPOS SENIOR LIVING
FACILITY NUMBER: 306003937

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/05/2024
Section Cited
HSC
1569.605

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1569.605-Liability insurance; coverage requirements:On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering
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Licensee agreed to read and understand HSC 1569.605 and submit proof to CCL by 2/5/2024.
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CONT...injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000)...This requirement was not met as evidenced by: The licensee failed to carry liability insurance while operating. CONTINUED...
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Type B
02/05/2024
Section Cited
CCR87205(a)(b)

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87205(a)(b)- Accountability of Licensee Governing Body:(a)The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation...(b)If the licensee is a corporation or an CONTINUED...
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Licensee agreed to read and understand CCR 87205(a)(b) and submit proof to CCL by 2/5/2024.
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CONT...association, the governing body shall be active, and functioning in order to assure accountability. This requirement was not met as evidence by Licensee failed to submit documentation requested for audit review. This poses a potential risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2024
LIC809 (FAS) - (06/04)
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