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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005539
Report Date: 12/20/2021
Date Signed: 12/20/2021 12:52:56 PM

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:RYYANN HOME CAREFACILITY NUMBER:
306005539
ADMINISTRATOR:CONSTANTINO, LORNAFACILITY TYPE:
740
ADDRESS:25102 SOUTHPORTTELEPHONE:
(949) 367-5577
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY:6CENSUS: 5DATE:
12/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:39 AM
MET WITH:Lorna constantinoTIME COMPLETED:
01:00 PM
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Licensing Program Analysts (LPAs) Ruth Martinez and Kevin Saborit-Guasch conducted an unannounced visit for the purpose of conducting a required annual inspection. LPAs were greeted and granted entry I to the facility by caregiver and explained the nature of the visit.

LPAs began the tour of the inside and outside of the facility. There are five residents in care and there are no active covid-19 cases in the facility. LPAs observed three residents in the living room and remainder in their bedrooms. All residents appeared to be clean and well taken care of. LPAs observed a check in station in the main entry of the facility. Facility staff is taking temperatures daily and documenting the results. LPAs observed required department postings, covid-19 precautionary postings in the facility as well as hand washing signs throughout the facility. LPAs observed the emergency disaster and evacuation plan. LPAs inspected residents’ bedrooms and appeared to be clean and sanitary. All bedrooms observed to have all required components. Resident bedrooms are all private with one resident per. All restrooms observed to have ample supply of soap/PPE and appeared to be clean. Facility has a supply of emergency food and water in the attached garage, LPAs toured the outside of the facility and observed several seating areas for the resident’s enjoyment. The facility has completed the LIC808 Mitigation Plan and the plan was approved by the department on April 30, 2021. LPAs were informed that all staff and residents have received their Covid booster shots.

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

This report was reviewed with the facility Administrator and a copy of this report was provided to the facility.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Ruth MartinezTELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021
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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