300606831-7-9-2025-22-AS-WVAS-DJEV7H-20250709161110

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300606831
Report Date: 07/09/2025
Date Signed: 07/09/2025 04:11:20 PM

Document Has Been Signed on 07/09/2025 04:11 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	FREEDOM VILLAGE		FACILITY NUMBER:	300606831
ADMINISTRATOR/ DIRECTOR:	HRAG H BEKERIAN		FACILITY TYPE:	741
ADDRESS:	23442 EL TORO ROAD		TELEPHONE:	(949) 472-4733
CITY:	LAKE FOREST	STATE: CA	ZIP CODE:	92630
CAPACITY: 533		CENSUS: 326	DATE:	07/09/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:03 AM
MET WITH:	Hrag Bekerian Administrator and Jackie Arreaga LVN		TIME VISIT/ INSPECTION COMPLETED:	04:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) William Vanegas conducted an unannounced visit for the purposes of conducting an annual inspection LPA Vanegas explained the purposes of the visit and was granted entry by Administrator (AD) Hrag Bekerian. LPA Vanegas toured the interior and exterior of the facility with AD Hrag Bekerian, the facility is a three storied facility with skilled nursing on the first floor, and assisted living on the 2nd and 3rd floor. The facility has a capacity of 533 and is approved for 233 non-ambulatory of which five may be on hospice. Currently assisted living has a total of 61 residents in care. LPA Vanegas observed there to be a library, beauty salon, and multiple common areas for residents to lounge in. During today's visit LPA Vanegas observed residents socializing in common areas, participating in daily activities, getting assistance in the beauty salon, and lounging in their respective rooms. LPA Vanegas toured resident bedrooms, and observed the bedrooms to have all required furnishings such as a bed, clean linens in good repair; meaning no strains or tears, a chair, reading lamp, chest drawers, and enough storage space available for personal belongings. LPA Vanegas observed all sharps, and hazards to be stored away and inaccessible to residents in care, LPA Vanegas observed all fire extinguishers to be fully charged and up to date. Individual room smoke detectors are tested in house by facility staff on a monthly basis. CONTINUED ON LIC809C

NAME OF LICENSING PROGRAM MANAGER: Armando J Lucero
NAME OF LICENSING PROGRAM ANALYST: William Vanegas
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: FREEDOM VILLAGE	FACILITY NUMBER: 300606831
	VISIT DATE: 07/09/2025

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LPA Vanegas observed facility restrooms to be clean and sanitary, and observed no mildew in the respective restrooms. Restrooms were observed to have the appropriate furnishings such as grab bars, slip resistant floor matts, and shower chairs available if needed. LPA Vanegas observed toilet and water faucets to be operational, and water tested between 110.8 and 120.1 degrees.

LPA Vanegas observed a two day supply of perishable food and a seven day supply of non-perishable food on hand, and a sufficient amount of emergency water on hand for residents in care. LPA Vanegas observed all required postings to be posted in visible common areas such as the PUB475, Ombudsman sign, residents rights, and rights to participate in a resident counsel.

LPA Vanegas observed the outside of the facility to have a shaded sitting area, and outside area was free of any hazards and debris. LPA Vanegas observed the outside area to be large enough to participate in outdoor activities upon resident request.

LPA Vanegas reviewed five resident files, and five staff files, all files (staff and resident) have all required documents. Staff annual training is up to date, and documented correctly. LPA Vanegas reviewed medication administration log and medications being administered to five different residents with LVN Jackie Arreaga, and all medications administered are being documented correctly. Per LPA Vanegas review medications are being administered per physicians orders.

Based on observations made during today's inspection no deficiencies will be cited per title 22 chapter 8 division 6 of the California Code of Regulations. An exit interview was conducted with LVN Jackie Arreaga and Hrag Bekerian, and a copy of this report was provided to the facility.

NAME OF LICENSING PROGRAM MANAGER: Armando J Lucero
NAME OF LICENSING PROGRAM ANALYST: William Vanegas
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/09/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2025

LIC809 (FAS) - (06/04)

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