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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005672
Report Date: 10/25/2021
Date Signed: 10/25/2021 11:49:14 AM

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:WELLINGTON, THEFACILITY NUMBER:
306005672
ADMINISTRATOR:HILES, LINDAFACILITY TYPE:
740
ADDRESS:24903 MOULTON PARKWAYTELEPHONE:
(949) 458-2311
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY:160CENSUS: 115DATE:
10/25/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Linda Hiles, AdministratorTIME COMPLETED:
12:03 PM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into the facility by receptionist. LPA met with Linda Hiles, Administrator and explained the nature of the visit.

LPA Martinez accompanied by Administrator began the tour of the physical plant of the facility. There are 115 residents in care and no active covid-19 cases in the facility. LPA observed residents throughout the facility relaxing, in their apartments and in activities. All residents appeared to be clean and well taken care of. LPA observed required department postings, covid-19 precautionary postings in the facility. Restrooms observe to have ample supply of soap/sanitize and appeared to be clean. LPA observed resident apartments to have all required components. Apartments/bedrooms appeared to be clean and sanitary. Resident bedrooms are apartment style bedrooms with one or two residents per. LPA upon entry observed an electronic check in station with temperature checks. Check in process is designed to follow covid-19 guidelines for entry into the facility. Facility is taking temperatures daily and documenting the results electronically. Facility has hand sanitizer units mounted on the wall throughout the facility. Facility has the back-up emergency food and water supply in storage unit. Facility has PPE supply as well rolling storage bins with PPE as need for isolation rooms. Facility has several seating areas in the outside of the facility for residents. The facility has completed the LIC808 Mitigation Plan, LPA reviewed and approved the plan on today’s visit. LPA emailed the signed and approved plan to the Administrator for their records.

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 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: 10/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2021
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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