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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006249
Report Date: 03/11/2024
Date Signed: 03/11/2024 04:56:20 PM


Document Has Been Signed on 03/11/2024 04:56 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:OC HOME OF LAGUNA NIGUELFACILITY NUMBER:
306006249
ADMINISTRATOR:ANGELES, LOIDAFACILITY TYPE:
740
ADDRESS:23962 HILLHURST DRIVETELEPHONE:
(949) 202-8908
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY:6CENSUS: 6DATE:
03/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Loida Angeles, TIME COMPLETED:
05:10 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Administrator Loida Angeles and explained the reason for the visit. LPA and Administrator toured the facility. Facility is a single story house with 7 bedrooms (1 bedroom is for staff), 5 bathrooms, kitchen/dining room, living room and a 2 car garage that is being used for storage. LPA observed the see something, say something poster posted in the living room. The poster is visible from the front door. LPA observed the fireplace is screened. The kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed the stove lights unassisted. LPA observed the knives are kept locked in a kitchen drawer. LPA observed all medications are kept locked in a cabinet. LPA observed the garage is kept locked and used for storage. LPA observed all bathrooms are clean and operational. Hot water in the bathroom located in between bedrooms 4 and 6 measured 117.8 degrees Fahrenheit. LPA observed all resident rooms had the required furnishings. LPA and the Administrator toured the backyard. LPA observed chairs in the patio for residents to sit outside. Both exit gates on either side of the house are operational. No bodies of water observed. No obstacles or hazards observed outside of the facility. LPA reviewed 3 staff files. No discrepancies observed. LPA reviewed 6 resident files. No discrepancies observed. LPA reviewed 3 residents medications, no discrepancies observed. LPA inspected the first aid kit. The first aid kit had all the required elements. The smoke detectors and carbon monoxide detectors tested operational. No obstacles or hazards observed inside of the facility. No deficiencies observed during the visit. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Joseph AlejandreTELEPHONE: 714-705-6018
LICENSING EVALUATOR SIGNATURE:
DATE: 03/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/11/2024
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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