Mirage Manor Home Care

Type of visit: Required - 1 Year

On today's date, LPA William Vanegas conducted an unannounced visit for the purposes of conducting an annual inspection. Upon arrival LPA Vanegas was greeted and granted entry to the facility by Administrator (AD) Maria A. Garcia. LPA Vanegas explained the purpose of the visit and began a tour of the facility and observed the following. The facility consist of a two storied building with seven bedrooms four of which are resident rooms, one of which is a staff room, and two of which are personal living quarters for the licensee. The facility also consists of four bathrooms two are designated for resident use, and two are designated for visitor and staff use. Additionally the facility has an attached two car garage. Additionally LPA Vanegas observed the kitchen area to be clean and free of any mildew or debris. LPA Vanegas observed a gas stove, microwave, dishwasher, and refrigerator. All appeared to be in good condition and tested operational. LPA Vanegas observed all resident bedrooms to be clean and sanitary. LPA Vanegas observed all bedrooms to have all required furnishings such as a reading lamp, chest drawers, a bed, clean linens in good repair meaning no strains or tares, and a closet for storing personal belongings. LPA observed rooms being big enough to walk about freely and no furniture or objects blocking door ways. LPA Vanegas observed resident bathrooms to be clean and free of any mildew or debris. LPA Vanegas observed the water faucets and toilets to be operational and bathroom showers had all required furnishing such as slip resistant floor matts, grab bars, and shower chair. LPA Vanegas observed the bathroom water temperature to be between 108.2 and 109.9 degrees. CONTINUED ON LIC809C LPA Vanegas observed all smoke and carbon monoxide detectors to be operational and in good repair. LPA Vanegas observed all fire extinguishers to be up to date, and fully charged. LPA Vanegas observed all the required postings to be posted at the entry way of the facility, and visible to guests and resident's in care. LPA Vanegas observed the outside of the facility to be clean, and free of any debris along emergency exit routes. LPA Vanegas observed side doors to be self latching and unlocked. LPA Vanegas reviewed six resident records, and two employee files. All files (Resident and Client) had all required documents. Staff training was completed and documented accordingly. LPA Vanegas observed first aid kit to have all required items such as scissors, tweezers, adhesive tape, bandages, a thermometer, and a first aid manual. LPA Vanegas reviewed medications and medication administration record (MAR) with AD Maria A. Garcia. LPA Vanegas observed for all medications to be administered per physicians orders, and documented correctly by staff on duty. Based on today's observations during the visit per California Code of Regulations tittle 22, no deficiencies will be issued. An exit interview was conducted with AD and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jan 13, 2026

Type of visit: Case Management - Incident

On February 5th, 2025 Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of a case management visit due to a Special Incident Report (SIR) received by the Orange Regional Office. SIR stated that resident sustained a small spinal fracture due to a fall that occurred at the facility. Upon arrival LPA Vanegas was greeted and granted entry to the facility by Care Giver (CG) Maria Garcia and LPA Vanegas explained the purpose of the visit. LPA Vanegas reviewed resident's file, resident's discharge paperwork, and two staff files that were present at the time of the incident and reviewed the following. Per resident discharge paper work resident was diagnosed with a Lumbar Vertebral Fracture. Per residents physician report resident is non-ambulatory and requires assistance with activities of daily living (ADL). Resident is also diagnosed with dementia. Per LPA Vanegas review of staff files, both staff members that were present are trained on care for individuals diagnosed with dementia, and postural supports. LPA Vanegas interviewed staff member that was present and a staff member that was not present and obtained the following information. Resident had just eaten dinner right before the fall, he was transferred from the dinning table to the living room couch. He was sitting close to the edge of the sofa and staff members were in the kitchen where they still had visual of the resident however they noted him scooting closer to the edge of the couch and observed him sliding down the couch where he subsequently fell and sustained his injury. LPA Vanegas attempted to interview resident however he could not recall the incident. Resident stated that he feels safe here, and that the staff treat him with respect, and he enjoys living here. Based on today's observations and interviews there is no risk to the resident's health or safety. No deficiencies will be cited based on title 22 regulations. An exit interview was conducted and a copy of this report was left at the facilitythe state’s words, verbatim · CDSS document, Feb 5, 2025

Type of visit: POC

On January 22nd, 2025 Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of conducting a plan of correction visit. Upon arrival LPA Vanegas was greeted and granted entry by Care Giver (CG) Maria Garcia. LPA Vanegas was able to obtain proof of correction for previous citations given during last annual inspection. CG Garcia provided proof of updated staff training, and per LPA Vanegas review staff is trained and it is documented. Per LPA Vanegas review medications are being documented correctly and being administered per physician orders. Plan of corrections for each citation have been cleared. Based on observations during today's plan of correction visit no citations will be issued per tittle 22 chapter 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jan 22, 2025

Type of visit: Required - 1 Year

On 01/07/2025 Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of annual visit. Upon arrival LPA Vanegas was greeted and granted entry to the facility by administrator (AD) Maria Garcia. LPA Vanegas explained the purpose of the visit and set up equipment once granted entry into the facility. LPA Vanegas conducted a tour of the facility and observed the following. This is a two storied home with seven bedrooms four of which are resident rooms, one of which is a staff room, and two of which are personal living quarters for licensee. This facility has four bathrooms two are resident bathrooms and two are for staff and visitors. The facility also has an attached two car garage. LPA Vanegas observed the kitchen to be clean and free of debris. LPA Vanegas observed a two day supply of perishable food and a seven day supply of non-perishable food with a sufficient amount of emergency water. LPA Vanegas observed a gas stove, microwave, dish washer, washer, and a dryer that were all tested and tested operational. Medications were observed to be centrally stored, locked, and inaccessible to residents in care. LPA Vanegas observed that there was no documentation that indicates the time and days that medications were being taken. Bubble packs were popped on different days making it unclear as to when the medications were taken or not. A deficiency was cited on today's date. LPA Vanegas observed smoke and carbon monoxide detectors to be operational, fire extinguisher was observed to be fully charged and up to date. LPA Vanegas observed resident bathrooms to be clean and free of debris and contained all required furnishings such as grab bars, slip resistant matts, and functional faucets and toilets. Water tested between 112.4- 114.8 degrees. CONTINUED ON LIC809C LPA Vanegas observed all resident rooms to be clean and sanitary and containing all required furnishings such as chest drawers, reading lamps, windows that are screened, a bed, a chair, storage space for personal belongings, and linens that are in good repair meaning no strains or tears. LPA Vanegas observed all the required postings to be posted however the PUB 475 posting was not the correct size a technical violation was given on today's date. LPA Vanegas reviewed five resident files and all resident files consisted of the required documents. LPA Vanegas also observed three staff records and one of the three staff records did not contain the required annual training a deficiency was cited on today's date. LPA Vanegas observed the backyard of the facility to be clean and consist of a seated area available to residents. LPA Vanegas observed the exit routes to be clean and free of debris. There are two exit routes that are not obstructed by any objects and the doors are self latching and unlocked. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Jan 7, 2025

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Jerome Haley and conducted an unannounced visit for the purpose of conducting a required one-year annual inspection. LPA Haley was greeted and granted entry by staff and explained the reason for the visit. During the inspection, LPA Haley observed all resident bedrooms and bathrooms. All resident bedrooms had the necessary elements and were in compliance with regulation guidelines. Hot water temperatures were measured in the range of 110 degrees Fahrenheit and 119 degrees Fahrenheit. In the kitchen, knives and sharp objects are kept locked at the bottom of the medication cabinet. At the top of the medication cabinet, there were two first aid kits with all the required elements. A perishable food supply that meets regulation requirements was observed in the refrigerator. A non-perishable food supply that meets regulation requirements was observed in the cabinets. The garage is used to store miscellaneous items. Walkways were free of obstruction. There was an addition refrigerator with an additional food supply. In the center of the garage there’s several facility items that are no longer being used. There was an emergency supply of water and an additional perishable food supply. A washer and dryer was observed and above the washer and dryer is a locked cabinet with soaps, detergents, and other cleaning items. On the way to the backyard there's a large room used as a facility office and used to store boxes of diapers, paperwork, and old files. The backyard was organized, and free of clutter. A table and chairs was observed. A locked shed used to store additional items was observed. A fully charged fire extinguisher was observed mounted on the wall near the dining room. Administrator Garcia will have the extinguisher serviced or replaced. Photos will be sent to LPA Haley. There are locked cabinet in the dining room area used to store staff, and resident files. Continued on LIC809C Smoke carbon monoxide detectors tested operational. During the inspection, LPA Haley reviewed, resident medication, and conducted interviews with residents and staff. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 16, 2024

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.