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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004598
Report Date: 07/29/2024
Date Signed: 07/29/2024 09:33:05 AM


Document Has Been Signed on 07/29/2024 09:33 AM - 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:DELIGHTFUL LIVINGFACILITY NUMBER:
306004598
ADMINISTRATOR:REBEKAH BUBOIFACILITY TYPE:
740
ADDRESS:26811 CARMENITA LANETELEPHONE:
(714) 600-5845
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 6DATE:
07/29/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:19 AM
MET WITH:Rebekah Buboi- AdministratorTIME COMPLETED:
09:40 AM
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Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose to clear the remaining deficiencies cited on July 12, 2024 from 8:30am -10:40am. Administrator Rebekah Buboi was advised of the visit by telephone approximately 8:25am and arrived on premise at 9:21am.
  • Deficiency cited under Title 22 Regulations 87303 Maintenance and Operation (a)The facility shall be clean, safe, sanitary and in good repair at all times. - The electrical covers were replaced by the Admin during the visit and the wall/trim was observed to be completed upon arrival.
  • Deficiency cited under Title 22 Regulations 87618 Oxygen Administration- Gas and Liquid (b) (3) Ensuring that the use of oxygen equipment meets the following requirements: (B) “No Smoking-Oxygen in Use” signs shall be posted in the appropriate areas. - Signs were posted in front of the residents' bedrooms and the front door.
  • Deficiency cited under Title 22 Regulations 87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. - R1's Physician's Report has been updated.


Facility has complied with the terms of the plan of correction. The deficiencies are now cleared.

An exit interview was conducted with Administrator Rebekah Buboi, and a copy of this report including the Letter of Deficiency Citations Cleared were provided at the end of the visit.
SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica ChoTELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:
DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/29/2024
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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