306005384-12-16-2024-22-AS-KSGH-DBZQRZ-20241216112447

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005384
Report Date: 12/16/2024
Date Signed: 12/16/2024 11:37:06 AM

Document Has Been Signed on 12/16/2024 11:37 AM - 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:	ALLORA SENIOR LIVING		FACILITY NUMBER:	306005384
ADMINISTRATOR/ DIRECTOR:	KEVIN ISMAILI		FACILITY TYPE:	740
ADDRESS:	27532 CABEZA		TELEPHONE:	(949) 436-5238
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 2	DATE:	12/16/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:30 AM
MET WITH:	Kevin Ismaili, Administrator		TIME VISIT/ INSPECTION COMPLETED:	11:40 AM

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 this day, Licensing Program Analysts (LPAs) Kevin Saborit-Guasch and Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPAs were greeted and granted entry by caregiving staff after introducing themselves and stating the purpose of the visit. Administrator Kevin Ismaili was notified via telephone and arrived later to assist with the inspection. There are currently two residents in care, none of which is receiving hospice care. LPAs observed residents relaxing in the facility’s common area or sleeping in their respective bedrooms. LPAs accompanied by facility caregiver toured the physical plant. The facility is a one-story house with a detached garage. The facility has two private and two shared bedrooms with one en-suite bathroom along with a shared bathroom. Bedrooms appeared clean and sanitary. LPAs observed all the resident bedrooms have the required furnishings. One resident has half-rails in place for postural support with another half-rail positioned lower on the bed but not in use according to staff statement. The appropriate physician order is on file, consultation provided on postural supports. All bathrooms appear clean and sanitary. Bathrooms were equipped with grab bars and non-slip mats. Hot water temperature measured slightly above the required temperature range and was adjusted down during the visit. LPAs observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. LPA observed knives locked in a secure drawer. A fire extinguisher is verified to be charged and mounted to the wall. Annual maintenance is however not apparent. Consultation provided. LPAs tested the smoke and carbon monoxide detectors which were found to be operational. The centrally stored medication is located in a locked cabinet in the living room. The detached garage is inaccessible to residents and is used for storage and for laundry. Cleaning supplies are located in the garage. CONTINUED ON FORM LIC809-C

Sheila Santos	TELEPHONE: (714) 334-2062
Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
	DATE: 12/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024

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: ALLORA SENIOR LIVING	FACILITY NUMBER: 306005384
	VISIT DATE: 12/16/2024

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CONTINUED FROM FORM LIC809
LPAs and caregiving staff toured the outside of the facility and observed it to be free of obstructions. LPAs observed a shaded outdoor seating area with furniture for resident use. The perimeter gates on both sides of the property are self-latching and can easily be opened in an evacuation. There are no bodies of water on the premises.

LPAs reviewed two resident records which include all necessary components. LPAs reviewed resident medication records. No discrepancies were observed. LPAs reviewed two staff records which were found to be complete. Training and CPR/First aid training reviewed and up-to-date. All staff are background cleared and associated to the licensed location accurately. Infection Control and Emergency and Disaster plans were both reviewed and are complete and accurate. Fire and emergency drills are conducted quarterly and documented as required.

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. Four consultations provided. An exit interview was conducted and a copy of this report was provided to a facility representative.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch	TELEPHONE: (714) 497-8754
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024

LIC809 (FAS) - (06/04)

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