306005413-2-4-2025-22-AS-MTEA-DDKQX2-20250204113248

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005413
Report Date: 02/04/2025
Date Signed: 02/04/2025 11:32:56 AM

Document Has Been Signed on 02/04/2025 11:32 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:	COAST SENIOR CARE 2		FACILITY NUMBER:	306005413
ADMINISTRATOR/ DIRECTOR:	VIANA, KRISTEN		FACILITY TYPE:	740
ADDRESS:	11861 LORALEEN STREET		TELEPHONE:	(714) 583-8067
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92841
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 6	DATE:	02/04/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:00 AM
MET WITH:	Kristen Viana		TIME VISIT/ INSPECTION COMPLETED:	11:45 AM

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Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. At around 8:00 AM, LPA Tea was greeted and granted entry into the facility by caregiver, Josephine Martin and explained the reason for the visit. Administrator (AD) Kristen Viana arrived shortly afterwards to assist with the visit. Facility is licensed for 6 non-ambulatory residents of which one may be bedridden, with a hospice waiver for four. Currently there are six residents, none on hospice during today's visit.

At around 8:30 AM, LPA Tea reviewed six resident files and one staff file. Residents files and staff files contained all required documentation. Administrator certificate expires on June 16, 2026.

LPA Tea along with the Administrator toured the facility at 9:28 AM. LPA toured the physical plant, checked food service, and the first aid kit. The home consists of 4 resident bedrooms, which two are shared, 1 caregiver room, 2 full bathrooms, living room, dining/sunroom, kitchen and attached garage. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly with an exception for one bathroom, grab bars were secure and shower was free of mold/mildew. Water temperature measured around 115.1 F degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. There are video cameras with no sound in the common areas to ensure the safety of the residents. First aid kit had all the required elements including dressing, bandages, tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked in a kitchen drawer. LPA also observed toxin substances to be secured and locked and inaccessible to residents in the garage. The fire extinguisher is fully charged. The facility’s last fire drill was conducted on December 1, 2024. Kitchen appliances are operational during today's visit. LPA

Annual Inspection continuation on LIC809-C

Alisa Ortiz	TELEPHONE: (714) 287-4084
Michael Tea	TELEPHONE: 714-703-2840
	DATE: 02/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025

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: COAST SENIOR CARE 2	FACILITY NUMBER: 306005413
	VISIT DATE: 02/04/2025

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toured the outside grounds and there is ample seating with shade and the exit gates are self-latching and operational on both sides. LPA observed emergency food and water supply in the garage. Facility provides activities like bingo, coloring, sometimes they go for walks. There is an exercise bike for the residents to use in the sunroom to have residents be active. An activities specialist comes weekly to the facility to do activities with the residents like baking, doing crafts, playing trivia and listening to music. At the time of the visit, LPA observed residents were leaving for their day programs and some were enjoying their breakfast.

At 9:45 AM LPA reviewed medication storage and administration. Medications are stored in a locked cabinet in the living room area. Medications are being administered per physician order. LPA interviewed clients regarding their quality of care and spoke to staff present regarding care provided.

Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with administrator, Kristen Viana and a copy of this report LIC809, 809-C, LIC858, LIC859, and LIC9102TV was read and provided to the facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Michael Tea	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025

LIC809 (FAS) - (06/04)

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