306004793-7-20-2026-22-AS-JALE-DW7247-20260720170329

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306004793
Report Date: 07/20/2026
Date Signed: 07/20/2026 05:03:46 PM

Document Has Been Signed on 07/20/2026 05:03 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:	SEASONS AT LAGUNA - 2		FACILITY NUMBER:	306004793
ADMINISTRATOR/ DIRECTOR:	HANNAH PICHON		FACILITY TYPE:	740
ADDRESS:	28961 PASEO DE OCASO		TELEPHONE:	(949) 340-6688
CITY:	LAGUNA NIGUEL	STATE: CA	ZIP CODE:	92677
CAPACITY: 6		CENSUS: 6	DATE:	07/20/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:15 PM
MET WITH:	Hannah Pichon, Jennifer Floresca		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) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with Administrator Hannah Pichon and explained the reason for the visit. Hannah Pichon's Administrator's Certificate expires on December 18, 2026. Facility is licensed for 6 non-ambulatory residents of which 6 can be bedridden and a hospice waiver for 6. The facility is a single story home. LPA and staff toured the facility. LPA observed the See Something. Say Something poster (PUB 475) posted in the main entry of the facility. The last emergency drill was conducted on May 7, 2026. The fire extinguisher in the kitchen is fully charged. The smoke detectors/carbon monoxide detectors tested operational. LPA observed in the shared bathroom in the hallway that there were 2 pairs of scissors unsecured in the vanity drawer. Hot water measured 116.2 degrees Fahrenheit in three (3) shared bathrooms. Two of the rooms have private bathrooms. LPA observed all 5 bathrooms are clean and operational. LPA observed all six 6 resident rooms have the required furnishings. LPA observed clean linens stored in the hall closet across from the shared bathroom. Medications are kept locked in the hall closet next to the dining room. LPA inspected the first aid kit. The First aid kit has all the required elements. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed knives are kept locked under the kitchen sink. The 4 burner gas stove lights unassisted. The knobs for the stove are kept secured when it is not in use. The garage is kept locked and used for storage. LPA observed the garage is used for storage of cleaning supplies and old furniture. LPA observed a 3 day supply of emergency food and water in the garage. LPA and staff toured the backyard. No bodies of water observed. There is a covered patio with a shaded seating area for residents to sit outside. Both exit gates are operational and self closing. LPA reviewed 6 resident files, no discrepancies observed. LPA reviewed 6 resident medications.

Sheila Santos
Joseph Alejandre
	DATE: 07/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026

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: SEASONS AT LAGUNA - 2	FACILITY NUMBER: 306004793
	VISIT DATE: 07/20/2026

NARRATIVE

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LPA observed Resident 4 (R4) did not have PRN Nystatin powder which has been prescribed and not discontinued. LPA reviewed 2 staff files. Both staff members are background cleared and associated to the facility. Both staff members have the required training and CPR/First Aid training. Facility has a dedicated internet device for resident use only. LPA consulted with the Administrator regarding reporting requirements. Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report provided along with appeal rights.

NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Joseph Alejandre
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026

LIC809 (FAS) - (06/04)

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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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Document Has Been Signed on 07/20/2026 05:03 PM - It Cannot Be Edited

Created By: Joseph Alejandre On 07/20/2026 at 04:41 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SEASONS AT LAGUNA - 2	FACILITY NUMBER: 306004793
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/20/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87309(a)

Storage Space and Access

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above, LPA observed in the shared bathroom in the hallway that there were 2 pairs of scissors unsecured in the vanity drawer, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 07/21/2026
	Plan of Correction
1 2 3 4	Licensee agrees to secure all sharp objects which could pose a danger to residents in locked storage.

Type A

Section Cited

CCR

87465(c)(2)

Incidental Medical and Dental Care Services

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication, but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in 1 out of 6 residents, LPA observed Resident 4 (R4) did not have PRN Nystatin powder which has been prescribed and not discontinued, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 07/21/2026
	Plan of Correction
1 2 3 4	Licensee agrees to order Nystatin powder for R4 which has been prescribed by their physician. Licensee agrees not to run out of PRN medication for any resident.

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

	Sheila Santos
NAME OF LICENSING PROGRAM MANAGER:

	Joseph Alejandre
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2026

LIC809 (FAS) - (06/04)

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