Lake Forest Residential Care Facility

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Celine Rodriguez conducted an announced pre-licensing visit to the facility and was greeted and granted entry by facility administrator (AD) Priscilla Celis. LPA observed the Administrator's Certificate for Liza Rebecca which expires on 9/17/2027, and Priscilla Celis which expires on 7/7/2027 and is posted in the hallway. LPA toured the exterior and interior portion of the facility with AD Celis. Structure: Facility is a single level structure. On 7/22/2025, The Orange County Fire Authority granted fire clearance for a capacity of 6 non-ambulatory residents (of which 6 may be on hospice and 2 may be bedridden (in room #1 and room #5). There are a total of 6 bedrooms, which there are 4 private resident rooms, 1 shared resident bedroom, and 1 for staff. There is a garage that is utilized as a storage and break room for staff. Bedrooms: All bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept hazard free. Bathrooms: The restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature in restrooms were measured to be at 113.2 degrees Fahrenheit. Linens and Hygiene Supplies: Adequate supply of linens is stored in the closet. Posters, Emergency Phone Numbers, Exit Plan: LPA observed the PUB475 "See Something, Say Something" poster posted at the entrance of the facility. Emergency disaster plan is located in the facility binder and is also posted in the living room. Food Service and Menu: Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care. Facility had back-up emergency food and water supply located in the kitchen and garage. Smoke and Carbon Monoxide Detectors: Smoke and carbon monoxide detectors were tested and operational. Alarms: All auditory exit alarms were tested and observed to be operational. Fire Extinguisher: Fully charged, mounted, located in the kitchen, and tagged for the date of 2025. Appliances: Stove is a four-burner induction stove, and there is single oven, dishwasher, refrigerator and freezer. Washer and dryer are located in the garage. Toxins: Locked and inaccessible to residents. Medications, PPE First-Aid Kit and Manual: LPA observed that First Aid Kit had all the required components. Medications are locked in a drawer. Backyard: No bodies of water were observed. There are 2 exit gates in the backyard, of which are self-closing and self-latching. Resident and Staff Files: Records were kept in a locked cabinet located in the living room. Recreational Activities: The facility has activities that commensurate with plan of operation. LPA Rodriguez reviewed the Component III with AD Celis. Per interviews, Licensee/Administrator stated that they are not planning to advertise for special dementia program for this facility as of this time. Prelicensing visit and Component III are now complete. LPA will provide copy of this report to Centralized Applications Bureau for review and final determination of the application. LPA Rodriguez conducted an exit interview with AD Celis, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Oct 14, 2025

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Priscilla Celis CEO/Administrator Interview Method: Telephone interview On September 23, 2025, Applicant/Administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of the following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-Licensing Readinessthe state’s words, verbatim · CDSS document, Sep 23, 2025