Laguna Hills Guest Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and was greeted and granted entry by staff. LPA met with care staff and explained the nature of the visit. There are five (5) residents at the facility and there is three (3) residents receiving hospice services currently. Michelle Solomon, Administrator arrived to the facility and met with LPA. LPA began the tour of the inside and outside of the facility. LPA observed required department postings throughout the facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishables foods and two days of perishables foods available. There is additional food storage in a spare refrigerator in the garage. The facility is maintained at a comfortable temperature. LPA inspected that medication is centrally stored in a safe locked storage cabinet located in the dining room. LPA reviewed medication and observed medication was labeled and stored inaccessible to residents in care. LPA inspected the facility bathrooms (2) and LPA measured the hot water temperature which measured 111.7 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper and towels. Bathrooms are equipped with required safety measures such as non-skid mats and grab bars. Lighting is sufficient to ensure safety and comfort. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPA observed that toxic chemicals, cleaning solutions and disinfectants are stored locked underneath kitchen sink and locked storage cabinet in the garage. The facility has an available clean supply of linens. LPA inspected residents’ bedrooms which has sufficient lighting to ensure the safety and comfort. All bedrooms observed to have all required components. Storage space is provided for residents in their bedroom. Smoke Continued on LIC809-C detectors/carbon monoxide detectors were tested and found to be operational. LPA toured the outside of the facility and observed outdoor passageways are free of obstructions. LPA observed there are shaded seating areas for residents’ enjoyment in the backyard of the facility. LPA observed a fire extinguisher with service date of October 17, 2025, charged and mounted in the living room. Fire drills are conducted every three months, LPA verified fire drill logs are kept and last drill was conducted October 2, 2025. LPA began reviewing records. LPA reviewed three resident records. All the required documentation was present and current in the residents’ files reviewed. LPA reviewed two employee records. All employees present have a criminal record clearance and are associated to the facility. LPA observed records reviewed have a current First Aid certificate. Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the Administrator, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Nov 4, 2025

Type of visit: Prelicensing

On this day, Licensing Program Analysts (LPAs) Kevin Saborit-Guasch and Samer Haddadin made a scheduled visit to the facility for the purpose of conducting a pre-licensing inspection. LPAs were greeted and granted entry by Michelle Solomon, administrator. An initial application for a license to operate as a Residential Care Facility for the Elderly was received by the Department on May 30, 2024 for a capacity of six non-ambulatory residents. This is a change of ownership with five residents already in care. Three of the currently admitted individuals are receiving hospice care. The applicant has requested a hospice waiver for six residents. LPAs accompanied by administrator toured the physical plant. The facility is a one-level home with a frontyard, backyard and attached garage. There are two shared bedrooms and two private bedrooms with one shared bathroom and one en-suite bathroom attached to one of the shared rooms. Each of the bedrooms include all necessary components of furnishing including a light, chair, storage space for personal items and a full-size bed as well as a supply of linen and bedsheets. Water temperature was measured within acceptable range at 110.7F. Common living spaces are present and a device connected to the internet is present for the use of the residents in care. Facility is clean, sanitary and free of odors in all areas inspected. Required posted documents are observed to be present. Kitchen equipment is present and operating as required. Sharp items and cleaning supplies are confirmed to be secured. A sufficient supply of perishable and non-perishable food is present as required by Title 22 Regulations. The centrally stored medication storage is located in a secure cabinet. The garage is used for additional storage. The laundry area is located in a central hallway, cleaning supplies are locked in the cabinet above. The entrance to the garage is also secured. Sound alarms are present on the ways of egress. CONTINUED ON FORM LIC809-D CONTINUED FROM FORM LIC809 Staff and five client records were reviewed and confirmed to include all necessary components. The fire clearance has been obtained on June 19, 2024 and provided to the Department before the pre-licensing visit. Combined smoke and carbon monoxide detectors are observed throughout the facility and confirmed to be functional. Fire extinguishers present on the premises are observed to be charged with current maintenance tags. First aid kit verified to be complete. First aid manual present. LPAs and licensee toured the outside of the facility and observed it to be free of obstructions. One shaded area is present in the backyard and is equipped with outdoor furniture for the enjoyment of residents and visitors. The perimeter gates present on both sides of the house are self-latching and can easily be opened in an evacuation. There are no bodies of water on the premises. Component III was waived as the prospective licensee has already been acting as the current facility administrator and operates other licensed locations as well. This report was reviewed with facility representative and a copy of this report was emailed to the applicant before the conclusion of the visit.the state’s words, verbatim · CDSS document, Oct 17, 2024

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census: 5 Method: Telephone call with CAB COMP II Participants: Solomon, Michelle On 9/10/24, the applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of 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 10, 2024