306006677-4-7-2025-22-AS-EKIM-DFHP27-20250407105528

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006677
Report Date: 04/07/2025
Date Signed: 04/07/2025 10:55:45 AM

Document Has Been Signed on 04/07/2025 10:55 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:	SOLAIRE HOME		FACILITY NUMBER:	306006677
ADMINISTRATOR/ DIRECTOR:	TUASON, LIEZL		FACILITY TYPE:	734
ADDRESS:	17777 BUENA VISTA		TELEPHONE:	(909) 841-6315
CITY:	YORBA LINDA	STATE: CA	ZIP CODE:	92886
CAPACITY: 5		CENSUS: 4	DATE:	04/07/2025
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:20 AM
MET WITH:	Applicant- Liezel Tuason		TIME VISIT/ INSPECTION COMPLETED:	11:15 AM

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	On April 7, 2025, at 8:20 AM, Licensing Program Analyst (LPA) Edward Kim conducted an announced visit to the facility to conduct the pre-licensing inspection. LPA Kim met with Applicant Liezl Tuason and toured the facility. An initial application to operate an Adult Residential Facility for Persons with Special Health Care Needs (ARFPSHN) was submitted to CCL on December 18, 2024. The facility is to have a capacity of five (5), five (5) can be nonambulatory and five (5) may be bedridden. Facility phone number (714-903-7277). LPA Kim observed the following. Structure: The facility is a one-story house with a detached 2 car garage with five (5) client bedrooms, three (3) bathrooms, basement, laundry room, dining room, a kitchen, and a living room. There are six (6) exits: one exit door in the dining room, one in the main entrance, two exits in the laundry room, one exit in the hallway next to Bedroom #3 and Bedroom #4, and one exit in the hallway next to Bedroom #5. Air/Heating: Central air/heating system installed with a central panel to control entire house located in the hallway. Temperature was at 73 degrees Fahrenheit Laundry Room The Laundry room has a washer, dryer, two file cabinets for client and staff files, a cabinet for locking up laundry supplies, and staff lockers. Evaluation Report Continues on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Edward Kim
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: SOLAIRE HOME	FACILITY NUMBER: 306006677
	VISIT DATE: 04/07/2025

NARRATIVE

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Client Bedrooms:
There are five (5) Client Bedrooms: Bedroom #1, Bedroom #2, Bedroom #3, Bedroom #4, and Bedroom #5. The bedrooms are spacious and will easily accommodate the residents' belongings. All resident rooms had the required furnishings.

Staff Bedrooms:
There are no staff bedrooms.

Bathrooms:
All bathrooms have a working toilet, wash basin, and shower. All bathrooms are clean. Shower mats were in all three bathrooms. Hot water was measured in all bathrooms. Hot water measured between 107.9 degrees Fahrenheit to 116.6 degrees Fahrenheit.

Basement
The basement entrance is located next to Exit #3 and is locked. This is where training is done and contains a large supply of Personal Protective Equipment (PPE).

Linens & Hygiene Supplies:
Adequate supply of linen stored in client bedrooms. Adequate supply of hygiene supplies are located in Bathroom #1 Cabinets.

Emergency Phone Numbers, Exit Plan & Menu:
Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed and posted in the client hallway. Menus posted and available information in kitchen.

Food Service:
There are 4 clients living in the facility currently. There is a 2-day perishable food. There is 7-day non-perishable food supply on hand. The emergency food is stored in the laundry room. Emergency water and emergency supplies are stored in the garage.

Evaluation Report Continues on LIC 809-C.

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Edward Kim
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2025

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: SOLAIRE HOME	FACILITY NUMBER: 306006677
	VISIT DATE: 04/07/2025

NARRATIVE

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Toxins:
All cleaning supplies and chemicals are kept in the garage and locked underneath the kitchen sink

Smoke Detectors/Carbon Monoxide Detectors:
Smoke detectors/carbon monoxide detectors are hardwired and tested operational. There are two fire extinguishers that are fully charged and were serviced on December 24, 2024 and are mounted in the basement and in the laundry room.

Outdoor/Yard:
There are three (3) outdoor locations for clients that are adequate for seating and for shaded areas. There are enough tables and chairs for all clients. All outdoor gates are self-closing and self-latching. There is a wheelchair swing located outside near exit #2.

Medications, First-Aid Kit & Book:
The first aid kit and all medications are stored in medical cabinet, which is in the kitchen to the right of the refrigerator. The first aid kit has all the required elements. The cabinet is kept locked.

Resident & Staff Files:
The Client and Staff Records will be kept locked in filing cabinets in the laundry room.

Reading Material, Games, Equipment & Materials:
Art supplies and activity supplies are stored in the living room and in the garage. There is a large screen TV in the living room. Each bedroom has individual large screen TV.

Appliances:
There is one five (5) gas burner stove which lights unassisted, oven, microwave oven, a refrigerator in the kitchen, a refrigerator in the laundry room, dishwasher, washer, and dryer. All appliances are clean and operational.

Evaluation Report Continues on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Edward Kim
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2025

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: SOLAIRE HOME	FACILITY NUMBER: 306006677
	VISIT DATE: 04/07/2025

NARRATIVE

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Fire clearance:
Fire Clearance approved by Orange County Fire Authority on December 30, 2024.

Component III:
Component three Orientation was completed with Applicant Liezel Tuason during the visit.

The pre-licensing visit and Component III Orientation are now complete. It appears this facility meets the requirements for licensure. LPA Kim will forward this report to the Centralized Applications Bureau for review. The license will be granted upon completion of a final review and approval from the Centralized Applications Bureau.

Exit interview was conducted and a copy of this report was left with Applicant Liezl Tuason.

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Edward Kim
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2025

LIC809 (FAS) - (06/04)

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