306006345-11-3-2023-22-AS-DLMN-CX8SM4-20231103135918

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006345
Report Date: 11/03/2023
Date Signed: 11/03/2023 01:59:38 PM

Document Has Been Signed on 11/03/2023 01:59 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:	SEA BLUFFS, THE		FACILITY NUMBER:	306006345
ADMINISTRATOR:	CASE, GREGORY		FACILITY TYPE:	740
ADDRESS:	25421 AND 25401 SEA BLUFFS DR		TELEPHONE:	(949) 234-3000
CITY:	IRVINE	STATE: CA	ZIP CODE:	92629
CAPACITY:	88	CENSUS: 53	DATE:	11/03/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Andrea Luther - Assistance Executive Director		TIME COMPLETED:	02:15 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 announced inspection to the facility for purpose of conducting a pre-licensing inspection for a change of ownership. LPA arrived at the facility and was greeted by Andrea Luther, Assistant Executive Director, Jill Libhart, Regional Director of Operations and Jenifer Larsen, Regional Director of Health Services. An application to operate a Residential Care Facility for the Elderly (RCFE) for (88) capacity, (0) ambulatory, (78) non-ambulatory, and (10) bedridden clients was received by Community Care Licensing (CCL) on 3/9/2022. Structure: The facility is comprised of two buildings. Building 1 is a three-story building. The first floor houses fourteen resident apartments, each with bathroom access, two offices, an open-use room, movie theater, medication room and communal bathroom. The second floor of Building 1 houses fourteen resident apartments, each with bathroom access, two activity rooms, computer room and two communal restrooms. The third floor of Building 1 houses eleven resident rooms, each with bathroom access, library, dining room and common bathroom. Building 2 is a two-story building. The first floor of Building 2 houses eighteen resident apartments, each with bathroom access, activity room, dining room, kitchen and medication room. The second floor of Building 2 houses twenty resident apartments, each with bathroom access, activity room, dining room, kitchen, medication and common area bathroom. LPA observed no sharps to be kept in any kitchen. Cleaning solutions and chemicals were locked in kitchen cabinets, laundry rooms and janitor closets. There are four laundry rooms across both buildings. LPA also observed locks on the doors to prevent resident access to kitchens, cleaning solution storage and laundry rooms. LPA observed the See Something, Say Something posters (PUB 475) mounted throughout the facility. There are two outdoor courtyards, one in each building. LPA did not observe any obstacles or hazards throughout facility. LPA observed fireplaces to be appropriately screened.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Dwayne L Mason	TELEPHONE: () -
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

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 ASC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: SEA BLUFFS, THE	FACILITY NUMBER: 306006345
	VISIT DATE: 11/03/2023

NARRATIVE

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Client Apartment: All resident apartments had the required furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. There is a signal system on each floor of both buildings. Care staff on designated floors receive alerts from clients on their floor using the signal system. If Care Staff on the designated floor cannot get to the client requesting assistance, they can reach out to Care Staff on other floors via walkie-talkie to get assistance to the client in a timely manner.

Medications, First-Aid Kit & Book: Medication is stored and locked in the various medication rooms throughout the facility. First aid kits have all the required elements and are stored in each medication room. Resident and staff files are stored in one of the medical file rooms.

Fire Extinguisher/Smoke and Carbon Monoxide Detectors: LPA observed the fire extinguishers to be fully charged with service tags indicating they were last serviced on 10/16/2023. Smoke detectors could not be tested without alerting local fire authorities. Detectors were last serviced on 10/16/2023.

Activities and Materials: The facility has a wide array of activities. These include but are not limited, fitness/wellness sessions, arts and crafts, puzzles, watercolors, books, virtual reality, games, a movie theater on site and planned outings. The facility also has a subscription to IN2L (It’s Never 2 Late) which is a service that empowers residents to develop and maintain their ability to use different types of technology.

Fire clearance: Was approved by a fire inspector of Orange County Fire Authority on 8/8/2023.

Bathrooms: All bathrooms have working plumbing. LPA measured hot water in sixteen bathrooms. Hot water in all bathrooms measured between 105 degrees Fahrenheit and 120 degrees Fahrenheit. Some bathroom temperatures briefly fluctuated outside of the 105-120 range, but all final readings measured between 105-120 degrees Fahrenheit. Regional Director of Operations stated they will have their maintenance person take a look at the water heaters as a precaution.

Emergency Phone Numbers, Exit Plan, Menu and Food: Posted and available for review. There is a supply of 2-day perishable and 7-day of non-perishable food on hand.

Based on today’s inspection, LPA has determined the facility is ready for their license. Exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Armando J Lucero	TELEPHONE: (949) 430-1222
LICENSING EVALUATOR NAME: Dwayne L Mason	TELEPHONE: () -
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

LIC809 (FAS) - (06/04)

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