Adagio San Juan

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced Plan of Correction (POC) visit to follow up on deficiencies cited on 08/25/2026. LPA was greeted and granted entry into the facility and explained the reason for the visit. Deficiency cited under Title 22 Regulation 87309(a) pertaining to Unsecured Toxins has been cleared. During today's visit, toxins and knives are secured. Licensee has complied with the POC. Deficiency cited under Title 22 Regulation 87465(h)(2) pertaining to Centrally Stored Medications has been cleared. Medications are secured during today's visit. Licensee has complied with the POC. Deficiency cited under Title 22 Regulation 87307(e)(1)(A) pertaining to Protective Mechanisms has been cleared. LPA observed facility is removing the cook top burners when not in use. Licensee has complied with the POC. Deficiency cited under Health and Safety Code 1569.695(c) pertaining to Emergency Drills has been cleared. Licensee provided proof of correction. Licensee has complied with the POC. Deficiency cited under Title 22 Regulation 87608(a)(3) pertaining to Postural Supports has been cleared. Licensee provided proof of correction. Licensee has complied with the POC. CONTINUED ON LIC 9099C DATED 09/08/2026 Deficiency cited under Title 22 Regulation 87411(h) pertaining to Personnel Requirements has been cleared. Licensee provided proof of correction. Licensee has complied with the POC. Licensee has been advised to maintain compliance in all items previously cited. Exit interview conducted and a copy of this report will be emailed to Administrator..the state’s words, verbatim · CDSS document, Sep 8, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Adagio San Juan. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the facility and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents, of which three may be bedridden. Facility has an approved hospice waiver for six residents and there are two residents on hospice care today. Administrator Amy Zuehl has an administrator certificate valid until August 3, 2027. Upon entry, facility appears clean, safe and sanitary. At 1:15 PM, LPA Lyman toured the facility along with Caregiver Maranan. LPA toured the physical plant, checked food service, first aid kit and reviewed records. Facility is a one story home with 6 bedrooms, 3 restrooms, living room, dining room, kitchen, and an attached garage. The garage is kept locked and used for storage. At 1:25 PM, LPA observed unsecured medications in the laundry room (photo). Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed four residents with bed rails. Resident restrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 111.9 and 112.4 degrees F in all facility restrooms. Resident toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. LPA observed the first aid kit with all the elements including thermometer, tweezers and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed unsecured knives and toxins in kitchen cupboards (photos). Facility does not have protective mechanisms on the cook top. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher is fully charged. The outside grounds were toured and there is ample shaded seating for residents. Exit gates are unlocked and operational. CONTINUED ON LIC 9099C DATED 08/25/2026 Emergency food and water was observed. The emergency disaster plan was reviewed during the visit. Facility does not have documented quarterly emergency drills. Facility provides activities in the form of exercise. LPA reviewed resident and staff files. Resident files contained required documents including admission agreements, physician reports and resident appraisals. Three out of five residents have documentation indicating being at risk if exposed to toxins or sharps. One out of four residents have a physician order for bed rails in the file. Staff files reviewed contained required documentation of medical clearance, training and criminal record clearance. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet. LPA observed staff are taking blood pressure for two residents with parameter medication orders. None of the staff are skilled professionals. Medications appear to be administered per physician order. Licensee to forward an updated LIC 500 and LIC 308 to LPA by close of business on September 8, 2026. Based on the observations made during today's visit, deficiencies are being cited per Title 22 division 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report along with appeal rights was provided.the state’s words, verbatim · CDSS document, Aug 25, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Joseph Alejandre made an announced visit to conduct the Pre-Licensing inspection. LPA met with applicant Herminia Zuehl. An initial application to operate a Residential Care Facility for the Elderly (RCFE) for 6 non-ambulatory residents of which 3 can be bedridden was submitted to Community Care Licensing (CCL) on February 10, 2025. Facility requested a hospice waiver for 6. Facility phone number 949-388-9219. Structure. The facility is a one story house with 6 bedrooms, 3 bathrooms, living room, kitchen, dining room, laundry room and an attached 2 car garage. LPA observed the fire extinguisher in the kitchen is fully charged. LPA observed the fireplace in the living room is screened. The key that operates the fireplace is kept locked. LPA observed the See Something, Say Something sign (PUB 475) posted next to the front door. Resident rooms. LPA observed all the resident rooms have the required furnishings and bed linens. LPA observed there is a TV in the living room with 3 chairs, a sofa and a loveseat. LPA observed extra linens store in the hallway linen closet. Bathrooms. Facility has 3 bathrooms and all bathrooms are clean and operational. Water Temperature. LPA measured the hot water at 114.9 degrees Fahrenheit in all bathrooms Emergency Phone Numbers & Exit Plan. LPA observed Personal Rights of Residents posted along with, the Facility's Theft and Loss Policy, Rights of Resident Councils and the Emergency Disaster plan, which contains emergency phone numbers for first responders. The facility sketch showing all emergency exits and exit routes is posted throughout the facility. Appliances. LPA observed the stove, oven and refrigerator are all clean and operational. The 5 burner gas stove lights unassisted. The washer and dryer in the laundry room and are clean and operational. Extra cleaning supplies are kept locked in cabinets in the laundry room. Food Service. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed a 3 day emergency supply of food and water stored in the garage. The garage is kept locked and used for storage. Toxins and cleaning supplies are kept locked in the hall closet. Clients & Staff Files are kept locked in a kitchen cabinet. Medications are kept locked in the medication closet in the living room. First-Aid Kit & Book are kept locked in medication closet. LPA observed the first aid kit has all the required elements. Reading Material, Games, Equipment & Materials. Reading materials and games are kept in the living room. Fire clearance, the fire clearance was approved by Orange County Fire Authority on April 8, 2025. Backyard No bodies of water observed. There is a table with an umbrella and chairs for residents to sit outside. The exit gate is operational and self closing. No obstacles or hazards observed in the backyard. Smoke Detectors/Carbon monoxide detectors tested operational. Component III: Waived, applicant is the owner/operator of other licensed facilities. No obstacles or hazards observed inside or outside of the facility. Facility has an internet device (Tablet) dedicated for resident use only. LPA observed the front door and sliding door in the dining room have alarms and sound when opened. No deficiencies observed during the visit. The facility is ready to be licensed. LPA informed the applicant that final approval for licensure will be approved by CAB (Central Applications Bureau) in Sacramento. Applicant stated they understood. Exit interview was conducted and a copy of this report was provided to the applicant.the state’s words, verbatim · CDSS document, Jul 28, 2025