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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005351
Report Date: 05/09/2022
Date Signed: 05/09/2022 03:11:32 PM


Document Has Been Signed on 05/09/2022 03:11 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:LA VIDA AT MISSION VIEJOFACILITY NUMBER:
306005351
ADMINISTRATOR:JUSTINE ORTIZFACILITY TYPE:
740
ADDRESS:27783 CENTER DRIVETELEPHONE:
(949) 364-6210
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92692
CAPACITY:150CENSUS: 97DATE:
05/09/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
02:16 PM
MET WITH:Justine OrtizTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced health and safety case management visit. LPA was greeted and granted entry into the facility by Executive Director Justine Ortiz and explained the reason for the visit.


During the visit, LPA toured the facility. LPA observed residents in the assisted living participating in activities and memory care residents relaxing in the common areas as well as participating in activities. All residents observed appeared clean and well taken care of. LPA randomly interviewed residents in the assisted living. Residents verbalized satisfaction with all aspects of facility and verbalized feeling safe and cared for. No health and safety issues noted during today's visit.






No deficiencies noted during today's visit. Exit interview conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:
DATE: 05/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/09/2022
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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