306005837-12-4-2024-22-AS-ARJR-DBMRSC-20241204121631

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005837
Report Date: 12/04/2024
Date Signed: 12/04/2024 12:16:38 PM

Document Has Been Signed on 12/04/2024 12:16 PM - 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:	ORCHARDS ASSISTED LIVING, THE		FACILITY NUMBER:	306005837
ADMINISTRATOR/ DIRECTOR:	CONK, KELLY		FACILITY TYPE:	740
ADDRESS:	1 AMISTAD DRIVE		TELEPHONE:	(949) 443-8900
CITY:	RANCHO MISSION VIEJO	STATE: CA	ZIP CODE:	92694
CAPACITY: 90	TOTAL ENROLLED CHILDREN: 0	CENSUS: 50	DATE:	12/04/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:37 AM
MET WITH:	Joel Niblett-Administrator		TIME VISIT/ INSPECTION COMPLETED:	12:30 PM

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On this day, Licensing Program Analysts (LPA) Alvaro Ramirez, Jr. and Brandon Lopez made an unannounced visit to the facility for the purpose of conducting the Required Annual Inspection. LPAs were greeted and granted entry to facility and met with Administrator (AD) Joel Niblett.

LPAs toured the interior and exterior portions of the facility with AD Niblett. During this visit, there were five caregivers and three Medication Technicians (MTs) on duty. The facility is a two level structure and is licensed for ninety non-ambulatory residents and has a hospice waiver for six. LPAs initiated random bedroom checks, of which bedrooms were observed to have furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Water temperatures in restrooms were measured to be between 106.8 and 109.4 degrees Fahrenheit.

Smoke and carbon monoxide detectors were operational and most recent fire inspection took place on September 25, 2024, of which inspection was passed. The fire inspection was completed by Dynalectric Service and Systems Group. LPAs tested the pendant signal system and observed that the pendants are working as designed. The restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided.

Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Facility had back-up emergency food and water supply. LPAs toured the kitchen and observed the weekly food menu. LPAs also observed the activities calendar which is posted in the hallway. Sharp items and knives were locked and inaccessible to residents in care. Fire extinguishers were charged, mounted and located in multiple areas of the facility. LPAs observed exit stairwells and each floor had an evacuation chair. Delayed egress doors were tested and operational.

CONTINUED ON LIC809-C...

Sheila Santos	TELEPHONE: (714) 334-2062
Alvaro Ramirez Jr.	TELEPHONE: 714-705-6007
	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

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: ORCHARDS ASSISTED LIVING, THE	FACILITY NUMBER: 306005837
	VISIT DATE: 12/04/2024

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For the exterior portion, LPAs observed patio furniture under shading, and the grounds were free of any hazards. LPAs observed the emergency disaster and evacuation plan, which is located in the mail room.

LPAs observed that First Aid Kit had all the required components. Medications were locked and inaccessible to residents in care. Toxins were also observed to be locked and inaccessible to residents.

LPAs reviewed five resident files and four staff files. LPAs conducted interviews with residents and staff.

For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations.

LPAs advised AD Niblett to use the general email address:
CCLASCPOrangeCountyRO@dss.ca.gov for any inquiries and to specify attention to the assigned LPA.

LPAs conducted an exit interview with AD Niblett and Assisted Living Director Pamela Lahr and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.	TELEPHONE: 714-705-6007
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2024

LIC809 (FAS) - (06/04)

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