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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004037
Report Date: 05/24/2024
Date Signed: 05/24/2024 03:10:08 PM


Document Has Been Signed on 05/24/2024 03:10 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:LOTUS SENIOR CARE, HUNTINGTON BEACHFACILITY NUMBER:
306004037
ADMINISTRATOR:RITA LEEFACILITY TYPE:
740
ADDRESS:7092 BLUESAILS DRIVETELEPHONE:
(949) 636-8007
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY:6CENSUS: 5DATE:
05/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:Staff, Jash CatayesTIME COMPLETED:
03:20 PM
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On 5/24/2024, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by caregiver and granted entry after stating the purpose of the visit. Administrator (AD) Rita Lee was not present to assist with the facility inspection on today's date. LPA spoke to the Administrator by telephone and consented Caregiver Jash Catayes to sign the report on her behalf.

The facility is licensed for six (6) non-ambulatory residents with approved for three (3) bedridden and hospice waiver for three (3) residents. Currently, there are zero (0) Hospice residents present during today’s visit.

Facility is a single story with a two-car garage home. The facility has eight bedrooms (five resident rooms and three caregiver rooms), and three bathrooms.

At around 9:15AM, LPA conducted a tour of the physical plant accompanied by Caregiver Jash Catayes, and the following was observed: All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the Resident's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured between 114.8 to 121.4 degrees F. A comfortable temperature of 73 degrees F. was maintained in the facility.



LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. LPA observed emergency food and water supply. LPA observed two fire extinguishers that were fully charged. A review of the Medication Records Administration (MAR) was conducted, and LPA observed the records are in compliance.

CONTINUED ON 809C
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2024
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: LOTUS SENIOR CARE, HUNTINGTON BEACH
FACILITY NUMBER: 306004037
VISIT DATE: 05/24/2024
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During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted.

LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted in November 2023. The facility has operational smoke and carbon monoxide detector's in bedrooms and common areas. The facility has current liability insurance on file effective 9/1/2023 - 9/1/2024. The facility is current on Community Care Licensing annual dues.

A review of five residents (R1-R5) service files and three staff (S1-S3) personnel files revealed to be complete. The facility has the current administrator's certification on file for Rita Lee # 6028783740 - Expiration 7/31/2024.

No deficiencies during this inspection visit.

An exit interview was conducted with Administrator Lee via telephone. A copy of the report was reviewed and provided.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2024
LIC809 (FAS) - (06/04)
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