306006598-12-11-2024-22-AS-JCHO-DBUNRC-20241211094119

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006598
Report Date: 12/11/2024
Date Signed: 12/11/2024 09:41:33 AM

Document Has Been Signed on 12/11/2024 09:41 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:	RADIANT HEARTS, LLC		FACILITY NUMBER:	306006598
ADMINISTRATOR/ DIRECTOR:	SANTIANEZ, RAY		FACILITY TYPE:	740
ADDRESS:	25321 MAXIMUS ST		TELEPHONE:	(949) 295-6854
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY: 6		CENSUS: 0	DATE:	12/11/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	07:00 AM
MET WITH:	Patricia Requilman- Co-Licensee Ray Santianzez- Administrator Minerva Sansano- Administrator		TIME VISIT/ INSPECTION COMPLETED:	10:00 AM

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Licensing Program Analysts (LPA) Jessica Cho arrived announced for the purpose of conducting a Pre-Licensing Inspection. LPA conducted the visit with Co-owner Patricia Requilman and Administrators Ray Santianez and Minerva Sansano. The initial application to operate a Residential Care Facility for the Elderly (RCFE) was received by the Department of Social Services on July 9, 2024 for age range 60 and over for five non-ambulatory and one bedridden residents.

LPA began the tour of the interior and exterior portion of the facility with Applicant and Administrators and observed the following:

Structure:

The facility is a single story property in a residential neighborhood comprised of five resident bedrooms and two resident bathrooms. LPAs observed all common areas including the living room, dining area, kitchen, and a detached two car garage which doubles as a laundry area. The backyard has one exit gate, and the patio has sufficient shading and seating.

Telephone Number:
Facility land line number (949) 446-6290 was tested and remains available.

Signal System:
A signal system to alert staff is centrally located in the living room and is working.

Bedrooms:
The resident bedrooms had all required components, are spacious, and easily accommodates the residents’ furnishings.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024

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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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: RADIANT HEARTS, LLC	FACILITY NUMBER: 306006598
	VISIT DATE: 12/11/2024

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Bathrooms:
The two bathrooms are clean and operational. Grab bars were secure and bath slip mats were in place.

Linens and Hygiene Supplies:
Clean linens and hygiene supplies were observed to be fully stocked in the closet.

Appliances:
Stove burners, microwaves, refrigerator, freezer, and washer/dryer were inspected and operating.

Resident and Staff Files:
Resident and staff records will be maintained on site in the medication closet.

Reading Material, Games, Equipment, & Materials:
The facility maintains reading material and games in the living room.

Emergency Phone Numbers/Exit Plan:
Posted in the entry way.

Postings:
The See Something, Say Something (PUB475) and the Ombudsman Posters were posted in the entry way as well as the Rights of the Resident Councils, Resident's Rights, Theft & Loss Policy, and the Activity Schedule. A copy of the Admission Agreement is available in a binder for visitors to review.

Food Service and Menu:
Supply of seven day non-perishable and two day perishables were observed. The sample menu was available and posted on the refrigerator for review. The emergency food/water supply was also available in the medication closet. Emergency food has a shelf life up to 30 years.

Smoke and Carbon Monoxide Detectors:
The dual functioning smoke/carbon monoxide detectors and auditory devices were tested and found to be operational.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024

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: RADIANT HEARTS, LLC	FACILITY NUMBER: 306006598
	VISIT DATE: 12/11/2024

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Fire Extinguishers:
Two fire extinguishers located in the kitchen area and garage were mounted, fully charged, and serviced.

Fire Clearance:
Approved on September 10, 2024 for 5 non-ambulatory and 1 bedridden. Please note that bedridden resident is permitted in Room #1 according to the approved facility sketch. All other rooms are for non-ambulatory residents.

Toxins and Sharps:
Cleaning supplies, toxins, and sharps were observed to be secured and inaccessible.

Water Temperature:
The water temperature in the two bathrooms measured at 114.2 and 111.9 degrees Fahrenheit.

Medications, First Aid Kit, & Manual:
The brand new and sealed First Aid Kit had all the required components. The first aid manual was also available.

Component III:

Component III was completed during today's visit.

The Pre-Licensing is now complete, and the facility is ready for licensure. The license will be granted upon completion of a final review and approval from the Licensing Program Manager and the Central Applications Bureau.

An exit interview was conducted with Co-owner Patricia Requilman and Administrator Minerva Sansano, and a copy of this report was provided at the end of the visit.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2024

LIC809 (FAS) - (06/04)

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