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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005700
Report Date: 03/10/2021
Date Signed: 03/10/2021 04:17:35 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:DEL SOL I RSLFACILITY NUMBER:
306005700
ADMINISTRATOR:MAYORGA, JONATHANFACILITY TYPE:
740
ADDRESS:26462 VIA DEL SOLTELEPHONE:
(949) 357-6255
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 6DATE:
03/10/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Administrator Jonathan MayorgaTIME COMPLETED:
04:00 PM
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As precautionary measures during the Coronavirus 2019 (COVID 19) pandemic, Licensing Program Analyst (LPA) Albert Marin made an announced teleconference visit to conduct pre-licensing visit and Component III Orientation. LPA met with Administrator Jonathan Mayorga; and stated the purpose of this visit.

On September 29, 2020, The Orange County Fire Authority granted a fire clearance of 6 non-ambulatory of which 1 may be bedridden.

At 2:02 PM, with the assistance from AD Mayorga, LPA Marin conducted a virtual tour of the facility using a video application. LPA observed six residents in care and two staff members on duty. The upper level holds the administrator’s office and staff room. The lower floor holds the common areas and resident's rooms. Two shared and two private rooms were provided with adequate furniture and storage spaces, working light fixtures, and clean linens. Hallways were well lit and kept free of tripping hazards. Hardwired smoke and carbon monoxide alarms, exit auditory alarms, and call system were tested and observed to be operational. Bathrooms (one common and one private in a shared room) were provided with grab bars and non-skid floor mats. Hot water was measured at 118 degrees Fahrenheit. Kitchen appeared clean and clutter free. Facility met the two day perishable and seven day non-perishable food stock requirements. Medications, sharp items and cleaning supplies were inaccessible to residents in care. Fire extinguisher was mounted and charged. First aid kit was available and kept secured in the medication closet. Fireplace was covered with a screen and rendered non-functional. Poster requirements were observed in the living area of the facility. Exterior features included an enclosed pool and rendered inaccessible to residents in care. Patio area had adequate furniture in good repair and free of tripping hazards. Exterior Side exit doors were self closing and self latching. After the tour, LPA Marin conducted Component III Orientation with AD Mayorga.

For this visit, the facility was observed to be in substantial compliance with Title 22 Division 6 of the California Code of Regulations.

The prelicensing inspection and Component III Orientation are now complete. LPA Marin will inform and submit this report to Centralized Application Bureau for final review.

LPA Marin conducted an exit interview with AD Mayorga. Copy of this report will be provided to AD via email.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Albert MarinTELEPHONE: (714) 309-7843
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2021
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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