374604065-4-26-2024-08-AS-LSIA-D4PW3L-20240426165608

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604065
Report Date: 04/25/2024
Date Signed: 04/26/2024 04:56:52 PM

Document Has Been Signed on 04/26/2024 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	LAGUNA ESTATES SENIOR LIVING		FACILITY NUMBER:	374604065
ADMINISTRATOR:	WESLEY LAVENDER		FACILITY TYPE:	740
ADDRESS:	1088 LAGUNA DRIVE		TELEPHONE:	(760) 434-7116
CITY:	CARLSBAD	STATE: CA	ZIP CODE:	92008
CAPACITY:	214	CENSUS: 108	DATE:	04/25/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Interim Executive Director Divinia Nunez		TIME COMPLETED:	06:00 PM

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Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Interim Executive Director Divinia Nunez.

According to the facility’s license, the facility serves 214 residents ages 60 and above, of which 23 are ambulatory and the remaining residents may be non-ambulatory, including 25 bedridden. Delayed egress was approved in building C1. Hospice waiver was approved for 25 residents. During today’s inspection, there were a total of 108 residents in care. This facility does feature a secured perimeter.

LPA, accompanied by Divinia, toured the interior and exterior of the facility, and inspected a sample of bedrooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility’s ambient internal temperature was 72 F. Hot water temperature at taps accessible to residents were all compliant: Bedroom B105 bathroom sink was 111.9 F, Bedroom B102 bathroom sink was 110.4 F, bedroom A111 bathroom sink was 114.1 F and bedroom C106A bathroom sink was 112.2 F.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Medications were labeled, as required, and stored in locked areas. (continued on next page, LIC 809-C)

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 767-2311
LICENSING EVALUATOR NAME: Liliana Silveira	TELEPHONE: (619) 481-0844
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: LAGUNA ESTATES SENIOR LIVING	FACILITY NUMBER: 374604065
	VISIT DATE: 04/25/2024

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A pool was present at the facility. The pool fence was at least 5 feet high and the fence did not obstruct the pool from view. The gates to enter the pool were self-latching. Per Divinia Nunez, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA interviewed multiple staff and residents. LPA reviewed multiple staff and residents records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained required documents. Confidential records were stored in locked areas. Divinia also presented proof of current/active business liability insurance.

No deficiencies were observed or cited during today's annual inspection.

An exit interview was conducted with Divinia, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

***NOTE: LPA left the facility for one hour during the visit.

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 767-2311
LICENSING EVALUATOR NAME: Liliana Silveira	TELEPHONE: (619) 481-0844
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024

LIC809 (FAS) - (06/04)

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