306004637-3-17-2025-22-AS-RMRT-DEV2CH-20250317171645

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306004637
Report Date: 03/17/2025
Date Signed: 03/17/2025 05:17:01 PM

Document Has Been Signed on 03/17/2025 05:17 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:	SOLEIL SENIOR LIVING		FACILITY NUMBER:	306004637
ADMINISTRATOR/ DIRECTOR:	LISA GAITAN		FACILITY TYPE:	740
ADDRESS:	23741 SINGAPORE STREET		TELEPHONE:	(949) 716-7614
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 6	DATE:	03/17/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:00 PM
MET WITH:	Lisa Gaitan, Administrator		TIME VISIT/ INSPECTION COMPLETED:	05:15 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) Rose Ruppert made an unannounced visit to the facility today to conduct an Annual Required Evaluation. LPA was greeted and granted entry by Lisa Gaitan, Administrator. The facility is a five bedroom, two bathroom, single story residence with an approved fire clearance of six non-ambulatory residents with a hospice waiver for six. The facility currently has a census of six residents in care with two on hospice. During today’s visit, LPA toured the facility and inspected the physical plant, including but not limited to testing all smoke detectors and testing hot water temperature in two of two resident bathrooms. The hot water temperature measured between 119.1 to 119.7 degrees Fahrenheit and all smoke detectors were operational. Resident bathrooms had grab bars and non-skid mats with covered trash cans. The fire extinguisher is charged and was serviced on June 4, 2024. The facility’s last fire drill was conducted on January 8, 2025. LPA inspected the facility food supply and observed the facility retained a minimum of two days perishable and seven days non-perishable food on hand. Knives and cleaning solutions were secured in the garage LPA observed medication storage and reviewed the centrally stored medications. Per review of medications, it is not clear if they are being given as prescribed. LPA advised Administrator to use the digital Adivantus system to inventory and account for medications. An LIC 809-D will be given. LPA toured the exterior of the facility and noted a shaded seating area and various seating areas in the backyard. There are no obstructions in passageways and the exterior gate is self-latching. LPA observed residents in the common area watching a movie. Residents were going to celebrate a St. Patrick's day dinner later in the day. (Continued on LIC 809-C)

Alisa Ortiz	TELEPHONE: (714) 287-4084
RoseMarie Ruppert	TELEPHONE: 714-703-2840
	DATE: 03/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025

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: SOLEIL SENIOR LIVING	FACILITY NUMBER: 306004637
	VISIT DATE: 03/17/2025

NARRATIVE

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(Continued from LIC 809)

LPA reviewed three of three staff training and fingerprint records and conducted a complete review of resident records. Staff #1 was not fingerprint cleared and was told to leave the premises. Guardian documentation showed prior fingerprints were incomplete and expired on March 2, 2025. A Civil Penalty will be given for $100 per day X 5 days on a LIC 421-BG. Staff #1 will re-submit fingerprints and cannot return to work until they are cleared.

LPA interviewed alert residents regarding their quality of care and spoke to staff present regarding care provided. LPA confirmed that administrator has a current administrator certificate, which is pending, and will expire on December 23, 2026.

The following deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations.
An exit interview was conducted with Lisa Gaitan, Administrator and a copy of this report was given to the facility along with a copy of the LIC 858, LIC 859; LIC 809-D and Appeal Rights.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: RoseMarie Ruppert	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/17/2025 05:17 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SOLEIL SENIOR LIVING	FACILITY NUMBER: 306004637
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

87355(e)(1)

87355 Criminal Record Clearance. (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA interview and record review the licensee did not comply with the section cited above in one of one staff (S1) which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/18/2025
	Plan of Correction
1 2 3 4	Staff #1 (S1) was asked to leave the facility. Administrator (AD) re-submitted fingerprints since S1's fingerprints were incomplete and were due by March 2, 2025. AD will notify LPA when S1 is cleared and can return to work at that time.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Alisa Ortiz	TELEPHONE: (714) 287-4084
RoseMarie Ruppert	TELEPHONE: 714-703-2840
	DATE: 03/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 03/17/2025 05:17 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SOLEIL SENIOR LIVING	FACILITY NUMBER: 306004637
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

87564(a)(6)

87465 Incidental Medical and Dental Care. (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation and medication review the licensee did not comply with the section cited above in three of three resident medicatons which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/31/2025
	Plan of Correction
1 2 3 4	Administrator (AD) will inventory all medications into their digital system Adivantus and provide training for all staff in dispensing medication. AD will submit training plan with staff signatures and reports showing resident medications are properly inventoried and updated. AD will submit POC by March 31, 2025.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Alisa Ortiz	TELEPHONE: (714) 287-4084
RoseMarie Ruppert	TELEPHONE: 714-703-2840
	DATE: 03/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025

LIC809 (FAS) - (06/04)

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