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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005527
Report Date: 07/14/2025
Date Signed: 07/14/2025 11:53:12 AM

Document Has Been Signed on 07/14/2025 11:53 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:AGAPE SENIOR HOMES LLCFACILITY NUMBER:
306005527
ADMINISTRATOR/
DIRECTOR:		FISCHER, LONNIEFACILITY TYPE:
740
ADDRESS:11442 NEWPORT AVETELEPHONE:
(714) 393-2308
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY: 6CENSUS: 3DATE:
07/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Administrator Lonnie FischerTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
NARRATIVE
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On July 14, 2025, 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. Administrator (AD) Lonnie Fischer was notified via telephone but could not arrive to assist with the inspection. LPA observed that Lonnie Fischer does not have a current Administrator certificate and has not submitted a renewal application to the Administrator Certification Bureau.

The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents of which one may be bedridden. The facility is a single story home with four resident bedrooms, one staff bedroom, five shared resident bathrooms, a living room, a dining room, a kitchen, a den, a computer room, and an attached two car garage. LPA, accompanied by a caregiver, conducted a tour of the interior portions of the facility. On today's visit, LPA observed three resident in care and two care giving staff present. LPA observed the See Something, Say Something poster, (PUB 475) mounted on the wall by the dining room. LPA inspected all four 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 a hallway closet. LPA inspected the five shared resident bathrooms and observed them to be clean. Bathrooms were equipped with grab bars and non-skid floor mats. Faucets and toilets were operational. Hot water temperature measured between 107.6 and 108.5 degrees Fahrenheit.

LPA observed the facility has a two day perishable and a seven day nonperishable food supply on hand in the kitchen. LPA observed kitchen appliances to be clean and operational. CONTINUED ON 809-C
Sheila SantosTELEPHONE: (714) 703-2857
Brandon LopezTELEPHONE: (714) 483-4521
DATE: 07/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2025
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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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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Document Has Been Signed on 07/14/2025 11:53 AM - It Cannot Be Edited


Created By: Brandon Lopez On 07/14/2025 at 10:50 AM
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: AGAPE SENIOR HOMES LLC
FACILITY NUMBER: 306005527

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/14/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87307(a)
Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA observed staff are currently living in the garage and in the den/library.
POC Due Date: 07/15/2025
Plan of Correction
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AD agreed for staff to remove their belongings from these areas. AD also agreed to provide a written plan to LPA stating what the living arrangements are going to be for these staff. AD agreed to provide the statement to LPA via email or fax by POC date.
Type A
Section Cited
CCR
87405(a)
All facilities shall have a qualified and currently certified administrator...

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA observed the current listed Administrator does not have a valid certificate. LPA observed the Administrator Certificate Bureau has not received a renewal application from the current listed Administrator.
POC Due Date: 07/15/2025
Plan of Correction
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AD agreed to submit a written plan to LPA on how he plans to either submit a renewal application or hire an Administrator for the time being. AD agreed to submit this written plan to LPA via email or fax by POC date.
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:
TELEPHONE: (714) 703-2857
Brandon Lopez
NAME OF LICENSING PROGRAM ANALYST:
TELEPHONE: (714) 483-4521
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2025


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: AGAPE SENIOR HOMES LLC
FACILITY NUMBER: 306005527
VISIT DATE: 07/14/2025
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LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed chemicals and toxins to be stored in a locked kitchen cabinet under the sink. LPA observed fire extinguishers to be mounted on the wall in the dining room and in the resident hallway. LPA observed fire extinguishers to be charged and purchased on November 14, 2024. LPA tested the individual smoke detectors/carbon monoxide detectors which tested operational.

LPA observed the centrally stored medication to be kept in a locked cabinet located in the kitchen. LPA observed the facility has a First Aid Kit and it had all the required components. LPA observed the door leading to the attached two car garage and storage room to be kept locked and inaccessible to residents in care. LPA observed chemicals and toxins to be stored in a locked cabinet in the garage. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA observed that a facility staff is currently living in the garage with all of their personal belongings located in the garage. LPA also observed the staff to have a bed, a night stand, and a television located in the garage.

LPA, accompanied by a caregiver, conducted a tour of the exterior portion of the facility. The exterior portion was observed to be free of hazards and obstructions. LPA observed a shaded outdoor seating area with furniture for resident use. LPA observed the perimeter gates 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 three resident files. All the required documentation were present and current in the resident file reviewed. LPA reviewed the residents' medication and medication records. LPA reviewed three staff files. All staff are background cleared and associated to the facility.

Based on the observations made during today's visit, a deficiency is being cited on the attached LIC809-D. An exit interview was conducted with Administrator Lonnie Fischer via telephone and the report was signed by an authorized facility representative. A copy of the report and Appeal Rights were provided. Administrator Lonnie FIscher was also advised of the facility's outstanding fee balance. Administrator Lonnie Fischer was advised to provide LPA proof of payment by end of business day July 18, 2025.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2857
LICENSING EVALUATOR NAME: Brandon LopezTELEPHONE: (714) 483-4521
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2025
LIC809 (FAS) - (06/04)
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