Mission Viejo Care Cottages 2

Type of visit: Required - 1 Year

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry by facility caregiving staff after introducing himself and stating the purpose of the visit. Administrator Brian Estorba was notified and arrived shortly afterwards to assist. There are currently three residents in care, one of which is receiving hospice care at this time. Residents are observed relaxing in their respective bedrooms. LPA accompanied by facility staff toured the physical plant. The facility is a one-story house with five bedrooms. There are two bathrooms used by residents, one of which is en-suite. None of the residents are bedridden at this time. All occupied bedrooms appear clean and sanitary. One resident uses half-length rails for postural support and one has full rails. Physician order for R1 and hospice plan of care for R2 reviewed during the visit. R2 only has an order for half-rails instead of full rails. Consultation provided. All resident bedrooms have the required furnishings. Bathrooms appear clean and sanitary and are all equipped with grab bars and slip mats. Hot water temperature measured at 114F in the shared bathroom. Unsecured cleaning products observed under both bathroom sinks. Type A deficiency cited. LPA observed the kitchen has a minimum two (2) day perishable and seven (7) day non-perishable food supply. Sharp items, cleaning supplies and the medication central storage located in the kitchen and living room are verified to be secure. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 Wall-mounted fire extinguishers are present and verified to be charged, however maintenance tags expired in May 2025. Type B deficiency cited. Carbon monoxide and smoke detectors were found to be present and operational. Emergency water supplies are stored in the garage. LPA and facility staff toured the outside of the facility. LPA observed a shaded outdoor seating area with outdoor furniture for resident use in the backyard. The identified route of egress is free of clutter and obstructions. There are self-latching gates on both sides of the premises. There are no bodies of water on the premises and the facility does not utilize either locked perimeters or delayed egress. LPA reviewed three resident records. The file for R1 did not show any completed reappraisal since 2022. Type B deficiency cited. LPA reviewed resident medication records and prescription orders with no discrepancies observed. LPA reviewed staff records for three staff members during the visit. One staff member (S1) present is found to have an incomplete background clearance application and is therefore not background cleared at this time. LPA requested the removal of S1 from the premises until the background clearance is issued. Type A deficiency and civil penalty cited and issued. Proof of current CPR training reviewed. Disaster drills are conducted quarterly. The administrator certificate is current. Based on the observation conducted during the present visit, two type A deficiencies and two type B deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted and a copy of this report along with appeal rights were provided to a facility representative.the state’s words, verbatim · CDSS document, Nov 12, 2025

The state marks this report as 7 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On this day, Licensing Program Analysts (LPAs) Kevin Saborit-Guasch and Brandon Lopez made an unannounced visit to the facility for the purpose of conducting the required annual inspection. LPAs were greeted and granted entry by facility caregivers after introducing themselves and stating the purpose of the visit. Administrator Bryan Estorba was notified by telephone and arrived later to assist with the visit. LPAs accompanied by facility staff conducted a tour of the physical plant and observed the following: the facility is a one-story home with an attached garage. The facility has four private bedrooms and one shared bedroom. All resident bedrooms have the required furnishings. LPAs observed all beds have linen and blankets. There are full rails used for postural support in two rooms. Physician orders for both were reviewed, along with the hospice plans of care. There is one shared bathrooms, which is observed to be equipped with grab bars and slip mats. Bathrooms faucets and toilets are operational. Water temperature was measured at 114.4F. There are currently four residents admitted to the facility, including one admission who is currently in a skilled nursing facility for rehabilitation. There are two residents receiving hospice care. LPAs observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. Drills are conducted quarterly and documented. LPAs observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Some canned good in the garage are however observed to be expired. Type B citation issued. Smoke and carbon monoxide detectors tested operational. Fire extinguishers present is fully charged and has been maintained in 2024. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 There is adequately shaded outside space with outdoor furniture present. There are self-latching gates on each side of the property, however one of the latching mechanism is stuck and does not allow passage. Type B citation issued. There are no bodies of water on the premises. Cleaning products and sharp items are confirmed to be inaccessible throughout the physical plant. The medication central storage is however observed to have been left unlocked at the onset of the visit. Identically, the hospice comfort kits are stored in unlocked boxes in the attached garage, which is accessed through a door which can be easily unlocked. Type B citation issued. The medication central storage was reviewed to be accurate and up to date with the resident's prescription orders. LPAs reviewed four resident files along with three staff records. Resident records include all necessary components. One admission agreement is missing one signature. Consultation provided. Review of the resident's records indicate a resident with diabetes who is stated to be self-administering their own insulin. Physician report review states the resident is not able to self-administer and monitor. Type B citation issued. All staff members on the facility's roster are confirmed to be cleared and associated with this particular licensed location. Training and CPR training verified to be up to date. Health screenings are on file for all staff members. COVID mitigation plan in use in lieu of Infection Control Plan. Consultation and form LIC9828 provided. Based on the observations made during today’s inspection, four type B deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. One consultation provided. An exit interview was conducted and a copy of this report along with appeal rights was provided to a facility representative.the state’s words, verbatim · CDSS document, Nov 22, 2024

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Case Management - Incident

This unannounced Case Management – Incident inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of a health and safety check and to follow up on a self-reported incident report received in the Orange County Regional Office (OCRO) on 01/30/24 regarding an incident involving Resident #1 (R1). LPA met with Administrator (AD) Miguelito Fajardo and discussed the purpose of the inspection. During today’s inspection, LPA toured the facility with AD and observed 2 staff and 6 residents present. LPA conducted health and safety checks on the residents present and observed no health and safety issues. LPA observed the facility to be clean and organized and found no health and safety issues. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations, the electricity and water were running, the facility had soap and paper towels, and the medications, sharps, and toxins were properly stored. LPA interviewed AD and requested and reviewed copies of the resident roster, staff roster, R1’s resident file, R1’s Kaiser Medical Records dated 01/16/24, and R1’s Kaiser Medical Records dated 01/27/24. Per AD, on 01/13/24 at 12:20AM, R1 had an unwitnessed fall. R1 was assisted by staff and assessed by AD and reported no pain. While facility staff were trying to transport R1 to urgent care on 01/13/24 at around 2PM, R1 complained of a high level of pain and could not be transported due to the pain, so 9-1-1 was called around 3PM. Per Kaiser Medical Records dated 01/16/24 and 01/27/24, R1 was later diagnosed at the hospital with multiple rib fractures. The facility did not obtain medical attention timely for R1. Based on the information obtained during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. A technical violation regarding resident records is also being issued. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Feb 13, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(g) · Plan of correction due date: Mar 12, 2024

87465 Incidental Medical and Dental Care … (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health… This requirement was not met as evidenced by: Based on interviews and documents, on 01/13/24 the facility did not call 9-1-1 immediately after R1’s fall and injury and only tried to take took R1 to urgent care the next day, which posed a potential health risk to persons in care.the state’s words, verbatim · CDSS document, Feb 13, 2024

Plan of correction: Licensee stated they will conduct training for staff on responding to resident injuries and calling 9-1-1 and will submit proof to LPA by POC due date.]