Dana Point Manor

Type of visit: Required - 1 Year

Licensing Program Analyst (LPAs) Kimberly Lyman conducted an unannounced visit to Dana Point Manor. The purpose of today’s visit was to conduct the annual required inspection. LPA was allowed entry into the home and met with Caregiver Susan Arevalo and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 6 residents and the home currently has 5 residents, with 2 residents on hospice. Administrator Ramil De Los Santos has an administrator certificate expiring on 09/27/2026. Upon entry, facility appears clean, safe and sanitary. LPA Lyman along with Caregiver Arevalo toured the facility at 10:56 AM. LPA toured the physical plant, checked food service, facility documentation and the first aid kit. The home consists of 5 resident bedrooms, living room, dining room, and kitchen as well as 4 restrooms. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed three residents with bed rails. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 107.7 degrees F and 110.8 degrees F in all restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. LPA toured the kitchen. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps as well as cleaning supplies secured in the kitchen. Kitchen appliances were operational during today's visit. Smoke detectors and carbon monoxide detectors are hardwired and tested operational during today's visit. Fire extinguishers were fully charged. Facility conducts quarterly emergency drills with the last drill conducted on 08/15/2025. Outside grounds were toured. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. CONTINUED ON LIC 809C DATED 11/25/2025 First aid kit contained all required items including tweezers, scissors and thermometer. Facility conducts activities in the form of music, exercise and arts and crafts. There is ample shaded outdoor seating for residents. Exit gates are unlocked, self latching and operational. LPA observed ample emergency food and water supply. LPA reviewed five resident files and three staff files. All resident files contained required documentation including admission agreements, physician reports, resident appraisals, and physician orders for bed rails as indicated. Staff files reviewed contained required documentation including required annual training, medical assessment/ TB, criminal record clearance and proof of CPR training. LPA reviewed medication storage and administration. Medications are stored in a locked closet. Medications appear to be administered per physician order. Licensee has been asked to provide an updated LIC 500 (Personnel report), LIC 610 (Emergency Disaster Plan), LIC 308 (Designation of Facility Responsibility) and a copy of liability insurance by 12/09/2025. Based on the observations made during today’s visit, NO deficiencies are being cited. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Nov 25, 2025

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit, based upon the deficiencies cited in LIC form 809D on 12/16/2024. LPA was greeted and granted entry into the facility and explained the reason for the visit. *Deficiency cited under Title 22 Regulation 87303(a) pertaining to Maintenance and Operation has been cleared. During today's visit, all noted items have been repaired. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87455(h)(2) pertaining to Centrally Stored Medications has been cleared. During today's visit, LPA observed medications have been secured. Licensee has complied with the terms of the POC. *Deficiency cited under Title 22 Regulation 87309(a) pertaining to Storage Space has been cleared. LPA observed toxins are secured during today's visit. Licensee has complied with the terms of the POC. Licensee has been advised to maintain all items especially those that were previously deficient in the facility in accordance with Title 22 Regulations. Copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Jan 3, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Kimberly Lyman and Fred Arias conducted an unannounced visit to Dana Point Manor. The purpose of today’s visit was to conduct the annual required inspection. LPAs were allowed entry into the home and met with Caregiver Susan Arevalo and explained the reason for the visit. Assistant Administrator Cristy Valerio arrived shortly during the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 6 residents and the home currently has 5 residents, with 3 residents on hospice. Administrator Cybele Magtibay has an administrator certificate expiring on 07/03/2026. Upon entry, LPAs observed the medication closet opened and unsecured. LPAs along with Assistant Administrator toured the facility at 7:46 AM. LPAs toured the physical plant, checked food service, facility documentation and the first aid kit. The home consists of 5 resident bedrooms, living room, dining room, and kitchen as well as 4 restrooms. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 110.3 degrees F and 118 degrees F in all restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit. At 8:05 AM, LPAs observed the door to the garage was unlocked and toxins were unsecured. LPAs toured the kitchen at 8:15 AM and observed the burners on the cook top are only usable with the use of aim and flame lighters which were unsecured during today's visit. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Medications were unsecured in the refrigerator. LPAs observed sharps as well as cleaning supplies locked under the sink. Kitchen appliances were operational during today's visit. Smoke detectors and carbon monoxide detectors are hardwired and tested operational during today's visit. Fire extinguishers were fully charged. LPAs reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducts quarterly emergency drills with the last drill conducted on 10/07/2024. Outside grounds were toured. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. CONTINUED ON LIC 809C DATED 12/16/2024. First aid kit contained all required items including tweezers, scissors and thermometer. Facility conducts activities in the form of music, exercise and arts and crafts. There is shaded outdoor seating for residents. Exit gates are unlocked and operational. LPAs observed the emergency food and water supply. LPAs reviewed five resident files and three staff files. All resident files contained required documentation including admission agreements, physician reports, resident appraisals, and physician orders for bed rails as indicated. Staff files reviewed contained required documentation including required annual training, medical assessment/ TB, criminal record clearance and proof of CPR training. LPAs reviewed medication storage and administration. Medications are stored in a locked closet. Medications are being administered per physician order. Licensee has been asked to provide an updated LIC 500 (Personnel report), LIC 610 (Emergency Disaster Plan), and LIC 308 (Designation of Facility Responsibility) by 12/30/2024. Based on the observations made during today’s visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided as well as appeal rights.the state’s words, verbatim · CDSS document, Dec 16, 2024