Laguna Senior Living

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. Facility is licensed for 6 non-ambulatory residents and a hospice waiver for 6. The facility is a one story house with 6 bedrooms, 1 staff room, 6 bathrooms, living room, laundry room, kitchen, dining room and an attached 2 car garage. The Administrator's certificate expires on July 30, 2026. LPA and staff toured the facility. LPA observed the See Something Say Something Poster (PUB 475) posted in the entry way of the facility. LPA observed the fireplace in the living room is blocked off by a piece of wood that has moved mounted in the opening, so the fireplace is not accessible and cannot be used. LPA observed the 4 burner cook-top lights unassisted. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. Knives are kept locked in a kitchen drawer. Medication is kept locked in a cabinet in the kitchen. Smoke detectors/carbon monoxide detectors tested operational. Staff reported that last fire (disaster) drill took place in January but there is no documentation for any disaster drill. LPA and staff inspected the resident rooms. LPA observed all resident rooms had the required bed linens and furniture. LPA observed Resident 1 (R1) had bed rails. Staff reported that R1 is no longer on hospice. LPA observed all bathrooms are clean and operational hot water measured 107.9 degrees Fahrenheit in the 2 shared bathrooms. LPA observed the garage is kept locked and used for storage of extra food and supplies. LPA and staff toured the backyard. No bodies of water observed. There are two shaded areas with chairs to sit outside. The exit gate is operational. No obstacles or hazards observed in the backyard. LPA reviewed 4 resident files and medications. LPA observed R1 did not have a doctor's order for bed rails in their file. LPA observed R1 did not have a pre-appraisal or a current appraisal/care plan. No other discrepancies observed. LPA reviewed 2 staff files, LPA observed Staff 1 (S1) had a negative TB test but did not have a completed health screening. Both staff members had the required training and CPR/First-Aid training. Both staff members are background cleared and associated to the facility. LPA observed facility does not have a internet device for dedicated resident use. 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 to the facility representative along with appeal rights.the state’s words, verbatim · CDSS document, Apr 28, 2026

The state marks this report as 7 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the pre-licensing inspection. LPA met with applicant Mary Dee Motter. An initial application to operate an Residential Care Facility for the Elderly (RCFE) for 6 non-ambulatory residents was submitted to Community Care Licensing (CCL) on September 6, 2024. Structure. The facility is a one story house with 6 bedrooms, 1 staff room, 6 bathrooms, living room, laundry room, kitchen, dining room and an attached 2 car garage. LPA observed games and puzzles stored in cabinets in the activity rooms. LPA observed the fire extinguisher in the laundry room is fully charged. LPA observed the fireplace in the living room has been closed and is no longer operational. LPA observed the See Something, Say Something sign posted next to the front door. Facility phone number is 949-503-1939. Furniture, LPA observed all the resident rooms have the required furnishings. Bathrooms. Facility has 6 bathrooms and all bathrooms are clean and operational. Water Temperature. LPA measured the hot water at 111.9 degrees Fahrenheit. Emergency Phone Numbers & Exit Plan. Posted at the main entry of the facility. Appliances. LPA observed the cook-top stove, oven and refrigerator are all clean and operational. Food Service. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the ktichen. Toxins and cleaning supplies are kept locked in the garage. Clients & Staff Files are stored in a cabinet in the dining room. Medications are kept locked in a kitchen cabinet. First-Aid Kit & Book are kept in the linen closet. LPA observed the first aid kit has all the required elements. Reading Material, Games, Equipment & Materials. There are board games and reading material in the living room. Fire clearance, the fire clearance was approved by Orange County Fire Authority on October 30, 2024 for 50 ambulatory clients. Backyard. LPA observed no bodies of water. There is a table with an umbrella and chairs for residents to sit outside The exit gate is latched and operational. No obstacles or hazards observed in the backyard. Smoke Detectors/Carbon monoxide detectors tested operational. Component III: Conducted with the applicant. Information provided on how to operate the facility in compliance with Title 22. No deficiencies observed. The facility is ready to be licensed. LPA informed the applicant that final approval for licensure will be approved by CAB 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 13, 2025

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 4 Interview Method: Telephone interview On 4/17/2025, applicant/administrator participated in COMP II. Identification of the applicant / administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant / 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 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, Apr 17, 2025