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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004637
Report Date: 08/24/2023
Date Signed: 08/24/2023 12:14:45 PM


Document Has Been Signed on 08/24/2023 12:14 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:SOLEIL SENIOR LIVINGFACILITY NUMBER:
306004637
ADMINISTRATOR:LISA GAITANFACILITY TYPE:
740
ADDRESS:23741 SINGAPORE STREETTELEPHONE:
(949) 716-7614
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 3DATE:
08/24/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:49 AM
MET WITH:Facility Administrator - Scott Branson TIME COMPLETED:
12:37 PM
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Licensing Program Analyst (LPA) Celine De Perio made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit, based upon the deficiencies cited in LIC form 809D on 08/14/2023. LPA De Perio explained reason for visit and was greeted and granted entry by staff on duty, who informed administrator (AD) Scott Branson about visit.

On 08/14/23, facility did not ensure that recertification was processed. This poses a potential health and safety risk to residents in care.

*Deficiency cited under Title 22 Regulation 87407(e) pertaining to Administrator Recertification Requirements has NOT been cleared.

Administrator has not begun the renewal process of recertification and did not provide proof to assigned LPA on or by the assigned and agreed upon date of 8/18/23.

Licensee has NOT complied with the terms of the POC - Civil penalty has been assessed and issued for failure to comply with the POC.

An exit interview was conducted with AD Branson. A copy of this report was provided and explained.

SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerioTELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2023
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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