<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005948
Report Date: 02/22/2024
Date Signed: 02/22/2024 03:02:28 PM


Document Has Been Signed on 02/22/2024 03:02 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 ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:AEGIS LIVING DANA POINTFACILITY NUMBER:
306005948
ADMINISTRATOR:NAZARETH, SHEILAFACILITY TYPE:
740
ADDRESS:26922 CAMINO DE ESTRELLATELEPHONE:
(949) 488-2650
CITY:DANA POINTSTATE: CAZIP CODE:
92624
CAPACITY:76CENSUS: 59DATE:
02/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:16 AM
MET WITH:Eric Medor - General ManagerTIME COMPLETED:
03:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Dwayne Mason Jr. made an unannounced visit to the facility for purpose of conducting required 1-year annual inspection. LPA arrived at the facility and was greeted at the facility by the Concierge, Ashley Stewart. Eric Medor, General Manager joined the LPA for the inspection upon LPA;s arrival. The LPA explained the reason for the inspection.

The two-story facility houses Assisted Living (AL) and Memory Care (MC) apartments. The first floor houses 10 AL apartments, 19 MC apartments, three activity rooms/areas, med room, two common dining rooms, 1 private dining room, kitchen, sitting areas, staff offices, family room, spa, two common bathrooms and courtyard. The second floor houses 36 AL apartments, reading room, salon, staff lounge and laundry room. LPA observed the facility to be clean and sanitary. LPA toured 4 apartments. All apartments have the necessary furnishings and private bathrooms. Hot water measured was observed to be between 105 and 120 degrees Fahrenheit. LPA observed all windows were screened. Medications are locked in the Med Rooms. The facility has an activity calendar including the following activities: exercise, comedy, religious activities, movie/tv shows, board games and more. There is a 2-day supply perishable food and a 7-day supply of non-perishable food on hand. Emergency food and water are located in storage on the second floor. LPA observed a walk-in refrigerator, a walk-in freezer, a walk-in pantry and noted the kitchen has working appliances and can be locked from all entrances. All and any toxic chemicals, cleaning solutions, laundry toxins and disinfectants are inaccessible to residents and will be stored and double locked in the laundry rooms. LPA reviewed a document called Fire Alarm & Emergency Communication System Inspection & Testing Form. This form indicated that the facility smoke/carbon monoxide alarms and sprinkler system were tested on 9/6/2023 by Southeast Fire & Security.All fire extinguishers are fully charged. The service tags indicates they were last serviced on 2/12/2024. Emergency Phone Numbers, Exit Plan, Activity Calendar & Menu are all posted and available for review.

No deficiencies were noted. LPA issued two technical assistances regarding the Disaster Plan and postings. An exit interview was conducted and a copy of this report was provided to the facility.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Dwayne L MasonTELEPHONE: () -
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3