306004628-1-31-2025-22-AS-JCHO-DDG33B-20250131165315

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306004628
Report Date: 01/31/2025
Date Signed: 01/31/2025 04:53:22 PM

Document Has Been Signed on 01/31/2025 04:53 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:	CASA DOCTORA III		FACILITY NUMBER:	306004628
ADMINISTRATOR/ DIRECTOR:	KRAMER, PAUL/ESTELA		FACILITY TYPE:	740
ADDRESS:	25492 MAXIMUS STREET		TELEPHONE:	(949) 380-7379
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 6	DATE:	01/31/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:12 PM
MET WITH:	Estela Kramer- Administrator		TIME VISIT/ INSPECTION COMPLETED:	05:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of conducting the Required 1-Year annual evaluation using the CARE Inspection Tool. LPA was greeted and granted entry by Caregiver Robinie Martin and explained the reason for the visit. Administrator Estela Kramer later joined to assist LPA with the visit. The facility is a single story structure located in a residential neighborhood. Facility is licensed to operate for four non-ambulatory, two bedridden, and maintains a hospice waiver for six residents. There are six residents in care with one receiving hospice care. Two caregivers were present and on duty. LPA observed the facility to be clean, sanitary, and operational. There are five resident bedrooms and two resident bathrooms. There is an additional bedroom occupied by two live-in staff next to the kitchen. All common areas were inspected including the laundry area within the attached two car garage. The residents' bedrooms were appropriately furnished. Beds and bedding supplies were in good condition, adequate lighting was provided, sufficient storage space for each residents' personal belongings were observed. Bathrooms were found to be in compliance, clean, and operational. The hot water temperature measured at 116.2 and 116.4 degrees Fahrenheit. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food available. The fireplace was screened. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. The exit gates were self-closing and self-latching. LPA observed sufficient seating and shading. The outdoor shed was secured. Two fire extinguishers were observed, charged, and serviced on April 23, 2024. The auditory devices and dual functioning smoke/carbon monoxide detectors were tested and operational. The auditory device was not tested in one resident's room per their request.

Lourdes Montoya	TELEPHONE: (714) -70-2870
Jessica Cho	TELEPHONE: 714-703-2853
	DATE: 01/31/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025

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: CASA DOCTORA III	FACILITY NUMBER: 306004628
	VISIT DATE: 01/31/2025

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LPA observed the emergency food/water in the pantry room and garage. Emergency evacuation drills are being conducted quarterly. The first aid kit contains all necessary elements. The first aid manual is available however is outdated. The facility land line number, (949) 380-7379, was tested and remains available. The liability insurance is also current. LPA observed the required 'See Something, Say Something' poster (PUB475) in the correct size. The Administrator's Certificate for Estela Kramer expires on September 12, 2026 and October 27, 2025 for Paul Kramer.

LPA conducted an audit of six residents' files and two personnel files. No discrepancies noted. Medications were audited. No discrepancies noted. Interviews were attempted and conducted for residents/staff.

The following items were noted and discussed with Admin Estela Kramer: to review and amend the Emergency Disaster Plan (LIC610E), to obtain the current edition of the first aid manual, to include the subject(s) covered on the evacuation drill logs, and to organize/prepare your emergency supplies/equipment(s).

Based on the observations made during today's visit, no deficiencies are being cited. Advisory Notes (LIC9102s) are being issued.

An exit interview was conducted with Administrator Estela Kramer, and a copy of this report and the LIC9102s were provided at the end of the visit.

SUPERVISOR'S NAME: Lourdes Montoya	TELEPHONE: (714) -70-2870
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2853
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025

LIC809 (FAS) - (06/04)

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