Crown Valley Senior Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Assistant Administrator Emelita Magdaluyo and explained the reason for the vsiit. Maria Jasmin Avila's Administrator's certificate expires on June 11, 2026. The facility is licensed for 6 non-ambulatory residents of which 1 can be bedridden and a hospice waiver for 6. The facility is a one story house with 5 bedrooms, 2 bathrooms, dining room, kitchen and living room with a screened fireplace and an attached 2 car garage. The garage is kept locked and used for storage. LPA and staff toured the facility. LPA observed the garage is used to store furniture and supplies. LPA observed a 3 day emergency supply of food and water stored in the garage. LPA and Emelita Magdaluyo toured the facility. During the visit Administrator Maria Jasmin Avila arrived at the facility. LPA observed the fireplace is gas operated and the key is kept locked in the kitchen. LPA observed the See Something, Say Something poster (PUB 475) posted next to the front door. LPA observed all resident rooms have the required furnishings. LPA observed both bathrooms are clean and operational. Hot water measured 116.0 degrees Fahrenheit in both bathrooms. LPA observed clean linens stored in the hall closet. LPA observed the kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. Knives and sharp objects are kept locked in a kitchen cabinet. Medication is kept locked in a cabinet. LPA observed the 5 burner cook-top stove lights unassisted. The 5 burner stove has safety devices covering all the knobs to prevent resident use. The fire extinguisher in hallway next to the kitchen is fully charged. Smoke detectors/carbon monoxide detectors tested operational. Facility has a dedicated internet device for resident use. Facility has a courtyard in the front of the facility. There is a storage shed in the front courtyard used to store supplies. The storage shed is kept locked. LPA and the Assistant Administrator toured the backyard. No bodies of water observed. There is a covered patio with chairs in the backyard. The exit gate is operational. No obstacles or hazards observed in the backyard. LPA reviewed 3 resident files and medications, no discrepancies observed. LPA reviewed 4 staff files. LPA observed all 4 staff have the required training and CPR/First aid training. No discrepancies observed. All staff members are background cleared and associated to the facility. No deficiencies observed during the visit. No deficiencies are being cited as a result of this visit. An exit interview was conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, May 4, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Administrator Maria Jasmin Avila and explained the reason for the visit. Maria Jasmin Avila's Administrator's certificate expires on June 11, 2026. The facility is licensed for 6 non-ambulatory residents of which 1 can be bedridden and a hospice waiver for 6. The facility is a one story house with an attached 2 car garage with 5 bedrooms, 2 bathrooms, dining room, kitchen and living room with a screened fireplace. LPA observed the fireplace is gas operated and the key is kept locked in the kitchen. LPA observed the See Something, Say Something poster (PUB 475) posted next to the front door. LPA observed all rooms have the required furnishings. LPA observed both bathrooms are clean and operational. Hot water measured 113.5 degrees Fahrenheit. LPA observed clean linens stored in the hall closet. LPA observed the kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. Knives and sharp objects are kept locked in a kitchen cabinet. Medication is kept locked in a cabinet. LPA observed the 5 burner cook-top stove lights unassisted. The fire extinguisher in hallway next to the kitchen is fully charged. The garage is kept locked and used for storage. LPA observed extra food and supplies stored in the garage. Smoke detectors/carbon monoxide detectors tested operational. There is no documentation for a current emergency disaster drill. Facility has a dedicated internet device for resident use. Facility has a courtyard in the front of the facility. There is a shaded seating area in the front courtyard. LPA and Administrator toured the backyard. No bodies of water observed. There is a covered patio with chairs in the backyard. The exit gate is operational. No obstacles or hazards observed in the backyard. LPA reviewed 4 resident files and medications, no discrepancies observed. LPA reviewed 4 staff files. LPA observed there is no documented t annual raining for 3 out of 4 staff members. No other discrepancies observed. All 4 staff members have current CPR training. 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 provided along with appeal rights.the state’s words, verbatim · CDSS document, May 28, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Joseph Alejandre made an announced visit to conduct the pre-licensing inspection. LPA met with applicant Maria Avila and toured the facility. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to CCL on March 8, 2024. The facility is to have a capacity of 6 nonambulatory of which one can be bedridden (in bedroom 5 only). Applicant has requested a hospice waiver for 6 residents. Facility phone number 949-503-1864. LPA observed the following. Structure: The facility is a one story house with an attached 2 car garage with 5 bedrooms, 2 bathrooms, dining room, kitchen and living room with a screened fireplace. There are 9 exits, a sliding glass door in each bedroom (5) and one in the kitchen (1) and living room (1). In addition an exit door is in the garage(1) and the front door (1). LPA observed the PUB 475 poster posted next to the front door. Air/Heating: Central air/heating system installed with a central panel to control entire house. Resident Bedrooms: There are 5 Resident Bedrooms. Bedroom number 2 is a shared room, the rest are private. Bedroom 5 is approved for 1 bedridden resident. The bedrooms are spacious and will easily accommodate the residents' belongings. All resident rooms had the required furnishings and linens. Medications, First-Aid Kit: The first aid kit is stored in a cabinet in the dining room. The first aid kit t has all the required elements. Medications will be stored in a cabinet in the kitchen. The cabinet is kept locked. Bathrooms: Both bathrooms have a working toilet, wash basin and walk in shower, Both bathrooms are clean and operational. In bathroom two, located in bedroom two (the shared room) the ceiling vent fan is not operational. The window screen in bathroom two has a large hole in it. Linens & Hygiene Supplies: Adequate supply of linen stored in the hall closet. Emergency Phone Numbers, Exit Plan & Menu: Posted & readily available for review an emergency disaster plan with means of exiting and emergency phone numbers listed. Menus posted and available. Menus prepared one week prior and listed for food served for one week. Food Service: There are no residents living in the facility at this time. There is 7-day non-perishable food supply on hand. Smoke Detectors/Carbon Monoxide Detectors: Smoke detectors/carbon monoxide detectors tested operational. The fire extinguisher mounted by the front door is fully charged. Appliances: There is one 5 gas burner stove which lights unassisted, 1 oven, microwave oven, a refrigerator, dishwasher, washer, and dryer. All appliances are clean and operational. Toxins: All cleaning supplies and chemicals are kept are locked in the garage. Knives are kept locked in a kitchen cabinet. Water Temperature: Hot water was measured in both bathrooms. Hot water measured between 111.7 to 112.6 degrees Fahrenheit. Resident & Staff Files: The Resident and Staff Records will be kept locked in the cabinet in the dining room. Reading Material, Games, Equipment & Materials: Reading material and board games are available and stored in the dining room cabinet. There is a large screen TV mounted in the living room. Fire clearance: Fire Clearance approved by Orange County Fire Authority Inspector Ryan Boselo on March 19, 2024. Backyard: The backyard has a covered patio. Both exit gates are operational. There is no furniture in the backyard. The backyard is not appropriately equipped for outdoor use. Component III: Component three waived during visit. Applicant is Licensee/Administrator of other licensed facilities. The following items must be corrected prior to licensing. The ceiling fan in bathroom two must be repaired. The window screen in bathroom two must be replaced. There must be a patio table and chairs for outdoor activities. The facility is not ready to be licensed. Applicant was informed today that the final approval will be processed by CAB (Central Applications Bureau) in Sacramento. Applicant was informed to contact the LPA to schedule the next pre-licensing visit when items listed above have been corrected. An exit interview was conducted and a copy of this report was left with the applicant.the state’s words, verbatim · CDSS document, May 8, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Joseph Alejandre made an announced visit to conduct the second pre-licensing visit. LPA met with applicant Maria Avila. LPA observed the following items have been corrected. LPA observed four chairs and a table outside. The chairs and table are in a shaded area outside the dining room. LPA observed the screen for the bathroom window in bathroom two has been replaced with a new screen. The new screen has no rips or tears. LPA observed the ceiling vent fan in bathroom two is now operational. The facility is ready to be licensed. LPA informed the applicant that the final approval will be processed by CAB (Central Applications Bureau) in Sacramento. Exit interview was conducted and a copy of this report was provided to the applicant.the state’s words, verbatim · CDSS document, May 8, 2024