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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005308
Report Date: 09/08/2026
Date Signed: 09/08/2026 12:52:43 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/08/2026 12:52 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:CRYSTAL CARE HOMEFACILITY NUMBER:
306005308
ADMINISTRATOR/
DIRECTOR:		LAUGUICO, CRISTINAFACILITY TYPE:
740
ADDRESS:9391 TOUCAN AVETELEPHONE:
(714) 553-8674
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY: 6CENSUS: 4DATE:
09/08/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Licensee Cristina LauguicoTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
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On September 8, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by care giving staff after explaining the purpose for the visit. Licensee (LI) Cristina Lauguico was notified via telephone and later arrived to assist with the inspection. LPA observed that Cristina Lauguico has a valid Administrator certificate which expires on September 5, 2027.

The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has an approved hospice waiver for three residents. The facility is a single story home with consist of five private resident bedrooms, two staff bedrooms, three resident bathrooms, a living room, a dining room, a kitchen, a family room, and attached two car garage. LPA, accompanied by the LI, conducted a tour of the interior portions of the facility. On today's visit, LPA observed four residents in care and two staff present. LPA observed the See Something, Say Something poster (PUB475) mounted on the wall by the entryway of the facility. LPA inspected all five resident bedrooms and observed them to be free of hazards. LPA observed resident bedrooms to have the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds to have clean linens and blankets. LPA observed additional linens to be stored in hallway cabinets. LPA inspected the three resident bathrooms and observed them to be clean. Bathrooms were equipped with grab bars and nonskid floor mats. Faucets and toilets were operational. Hot water temperature measured between 107.4 and 111.3 degrees Fahrenheit. LPA observed the two staff bedrooms to be kept locked and inaccessible to residents in care.

LPA observed the facility has a two day perishable and a seven day nonperishable food supply on hand in the kitchen. LPAs observed kitchen appliances to be clean and operational. CONTINUED ON LIC809-C
Sheila Santos
Brandon Lopez
DATE: 09/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2026
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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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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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: CRYSTAL CARE HOME
FACILITY NUMBER: 306005308
VISIT DATE: 09/08/2026
NARRATIVE
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LPA observed fire extinguishers to be mounted on the walls in the kitchen and in the resident hallway. LPA observed fire extinguishers to be charged, however, they were last serviced on July 9, 2025. LPA tested the wired smoke detectors and carbon monoxide detectors which tested operational. LPAs observed the facility conducted their last emergency disaster drill on June 11, 2026. LPA observed the centrally stored medication to be kept in a locked cabinet located in the family room. LPA observed the facility has a first aid kit stored in the same locked cabinet and it had all the required components. LPA observed the door leading to the attached two car garage to be kept locked and inaccessible to residents in care. LPA observed the garage to be used for storage and laundry. LPA observed kitchen knives and sharps to be stored in the garage. LPA observed chemicals and toxins to be stored in the garage. LPA observed the facility also has a three day emergency food and water supply stored in the garage.

LPA, accompanied by the LI, conducted a tour of the exterior portion of the facility. The exterior portion was observed to be free of any hazards or obstructions. LPA observed a shaded outdoor seating area with furniture for resident use. LPA inspected a shed located in the backyard which was observed to be kept locked and used for storage. LPA observed the perimeter gate of the facility to be self latching and can be opened in an evacuation. There are no bodies of water on the premises.

LPA reviewed all four resident files. All the required documentation were present and current in the resident files reviewed. LPA reviewed the residents' medication and medication records. LPA reviewed three staff files. LPA observed that the facility did not have any documented annual training on file for Staff #2 (S2) for the year of 2025. All staff are background cleared and associated to the facility.

Based on the observations made during today's visit, deficiencies are being cited on the attached LIC809-D page. An exit interview was conducted with Licensee Cristina Lauguico. A copy of the report and appeal rights were provided at time of visit.
NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Brandon Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 09/08/2026 12:52 PM - It Cannot Be Edited


Created By: Brandon Lopez On 09/08/2026 at 12:32 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: CRYSTAL CARE HOME
FACILITY NUMBER: 306005308

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/08/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/18/2026
Section Cited
CCR
87203

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87203 Fire Safety: All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.

This requirement is not evidenced by:
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The Administrator stated that she will service the two fire extinguishers of the facility. The Administrator agreed to provide LPA proof of service via email or fax by POC due date.
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Based on observations, the Licensee did not comply with the regulation cited as the two fire extinguishers of the facility were not serviced annually as required. The fire extinguishers were last serviced on 7/9/25. This poses a potential health and safety risk to persons in care.
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Type B
09/18/2026
Section Cited
HSC1569.625(b)(2)

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ยง1569.625 Staff training; legislative findings; contents: (2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually...

This requirement is not evidenced by:
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The Administrator stated that she will have S2 complete the required annual training. The Administrator agreed to provide LPA proof of completed training via email or fax by POC due date.
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Based on records reviewed, the Licensee did not comply with this regulation as there is no documented annual training on file for Staff #2 (S2) for the year of 2025. This poses a potential health, safety, and personal rights risk to persons in care.
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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:
Brandon Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/08/2026


LIC809 (FAS) - (06/04)
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