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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006291
Report Date: 04/11/2024
Date Signed: 04/11/2024 11:12:18 AM


Document Has Been Signed on 04/11/2024 11:12 AM - 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:WE CARE SENIOR LIVINGFACILITY NUMBER:
306006291
ADMINISTRATOR:SANSANO, CHERYLFACILITY TYPE:
740
ADDRESS:24891 BRANCH AVETELEPHONE:
(949) 395-0586
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY:6CENSUS: 5DATE:
04/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:44 AM
MET WITH:Facility Administrator - Cheryl SansanoTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Celine De Perio and LPA Faith La conducted an unannounced required annual inspection LPA De Perio explained reason for visit and was greeted and granted entry by staff on duty. During the visit, staff on duty contacted facility administrator (AD) Cheryl Sansano about visit. The PUB475 "See Something, Say Something" poster was observed to be posted at the entrance of the facility. LPAs observed the Administrator's Certificate for Cheryl Sansano, which expired on 6/19/23, however provided proof to LPAs that a renewal application was submitted on 2/23/23, and is pending.

LPAs toured the interior and exterior portions of the facility with AD Sansano. The facility is a two level structure and is licensed for 6 non-ambulatory residents of which 1 may be bedridden, and 6 hospice. For this visit, there are a total of 5 residents in care, of which none are on hospice, and 1 bedridden. For the first level, there are are a total of 4 bedrooms, of which 2 are private resident rooms, and 2 are shared resident rooms. On the second level, there are a total of 2 bedrooms, which are designated only for staff. LPAs verified that there are no residents residing on the second floor. LPAs toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of 3 restrooms in the facility, of which 2 are designated for residents on the first floor, and 1 bathroom designated for staff on the second floor. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature in restrooms were measured to be at 109.4 degrees Fahrenheit.

Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care. Fire extinguisher was charged, mounted and located in the hallway.

SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Celine DePerioTELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2024
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 2


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: WE CARE SENIOR LIVING
FACILITY NUMBER: 306006291
VISIT DATE: 04/11/2024
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LPAs observed the emergency disaster and evacuation plan, which is posted at the entrance. Facility had back-up emergency food and water supply, located in the kitchen and in the garage. LPAs observed that First Aid Kit had all the required components. Medications and toxins were locked and inaccessible to residents in care.

For the exterior portion, LPAs observed patio furniture under shading, and the grounds were free of any hazards. There are 2 gates in the backyard, which were self-closing and self-latching. No bodies of water were observed.

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

No citations were issued.

An exit interview was conducted with AD Sansano.

A copy of this report was explained and provided.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Celine DePerioTELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2024
LIC809 (FAS) - (06/04)
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