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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005351
Report Date: 03/25/2022
Date Signed: 03/25/2022 03:06:49 PM


Document Has Been Signed on 03/25/2022 03:06 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: 94DATE:
03/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Justine OrtizTIME COMPLETED:
03:00 PM
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Licensing Program Analysts (LPAs) Kimberly Lyman and Andrea Mendivil conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPAs were greeted and granted entry into the facility and explained the reason for the visit. Executive Director Justine Ortiz has a current administrator certificate expiring on 11/4/2023.

At 1:00 pm, LPAs toured the facility with Executive Director Justine Ortiz. Facility has 94 residents in care during today's visit with 13 residents on hospice care. Facility consists of Assisted Living with Memory Care. LPAs observed a library, fitness room, salon, spa, movie room, card room, and activity room. LPAs observed residents relaxing in the facility or participating in activities. All residents appeared happy and well taken care of. Facility appears clean and sanitary. All resident rooms had the required elements as well as restrooms stocked with soap/ sanitizer. Rooms are single occupancy in Assisted Living and double occupancy in Memory Care. Facility screens all visitors to the facility and LPAs observed the screening/ sanitizing station in the facility. Facility utilizes an electronic visitor sign in sheet. Facility takes resident and staff temperatures daily and documents. LPAs observed the first aid kit has all required items. Facility mitigation plan has been approved. Facility has emergency evacuation chairs at the top of stairwells. LPAs observed an ample supply of emergency food and water. LPAs observed multiple outside visitation areas. LPAs observed the medication room and facility uses electronic medical records for medication management. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation and quarantine. LPAs reviewed select resident files during the visit and all files are up to date including emergency information. Most residents and staff are vaccinated for Covid-19.
LPAs consulted with Executive Director on the importance of posting the "Let Us No" in the entrance of facility in regulation size, 20"X26"
No deficiencies noted during today's visit. An exit interview was 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: 03/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/25/2022
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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