306004782-10-3-2022-22-AS-KSGH-CJUSU7-20221003141040

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306004782
Report Date: 10/03/2022
Date Signed: 10/03/2022 02:10:48 PM

Document Has Been Signed on 10/03/2022 02:10 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	PLEASANTVIEW HOME, THE		FACILITY NUMBER:	306004782
ADMINISTRATOR:	PATRICK JOHN BESINGA		FACILITY TYPE:	740
ADDRESS:	28911 LA LITA LANE		TELEPHONE:	(949) 364-1933
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92692
CAPACITY:	6	CENSUS: 5	DATE:	10/03/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Mariza Oliva, Administrator		TIME COMPLETED:	02:30 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	On 10/03/2022 at 12:45pm, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility in order to conduct a required annual inspection mostly focused on Infection Control procedures. LPA was greeted and granted entry by caregiving staff after undergoing the COVID-19 screening procedure and explaining the purpose of the visit. Administrator Mariza Oliva was notified by phone and arrived shortly afterwards to assist with the visit. At approximately 1:25pm, LPA accompanied by administrator toured the physical plant of the facility. There are currently five (5) residents in care, two (2) of which are receiving hospice care. Residents are observed relaxing in their respective bedrooms. All appear clean and well taken care of. The bedrooms include all necessary components of furnishing. Bathrooms are equipped with grab bars and slip mats. Facility is clean, sanitary and free of odors in all areas inspected. An ample supply of linen is observed. Physician orders for the resident whose beds is equipped with postural support are kept in the residents files and presented to LPA when requested. Sharp instruments are kept in a lockbox in the kitchen. Cleaning supplies are located in locked cabinets under the bathroom sinks as well as in the detached garage. The centrally stored medication is located in a locked cabinet in the dining room. LPA observed a sufficient supply of food and water present. LPA observed the facility has COVID-19 Precautions posters and all required department postings along with hand washing signs. The fire extinguisher present is charged and has up-to-date maintenance shown on the attached tag. Staff present is adequately cleared and associated in Guardian. CONTINUED ON FORM LIC809-C

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: 714-703-2851
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: PLEASANTVIEW HOME, THE	FACILITY NUMBER: 306004782
	VISIT DATE: 10/03/2022

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CONTINUED FROM FORM LIC809

LPA and administrator toured the outside of the facility and observed it to be free of obstructions. Outdoor furniture and a shaded area are present in the backyard for the enjoyment of residents and visitors. The entrance gate in front of the house is self-latching and can easily be opened in an evacuation. There are no bodies of water on the premises.

Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. A Technical Advisory on the posting requirements for administrator certificates is issued. This report was reviewed with facility representative and a copy of this report along was provided and left at facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: 714-703-2851
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2022

LIC809 (FAS) - (06/04)

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