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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002173
Report Date: 02/13/2026
Date Signed: 02/13/2026 11:01:05 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/13/2026 11:01 AM - 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:ARBOR VIEWFACILITY NUMBER:
306002173
ADMINISTRATOR/
DIRECTOR:		FISK, MARK & ERINFACILITY TYPE:
740
ADDRESS:26851 LA SIERRA DRIVETELEPHONE:
(949) 295-9191
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 0DATE:
02/13/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Mark Fisk - LicenseeTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
NARRATIVE
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On February 13, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting the Required 1 Year Inspection. LPA observed three old mattresses in the driveway. LPA Bentley contacted Licensee (LI) Mark Fisk by telephone at 8:16am and stated the purpose of the visit. LI stated that the facility is closed due to renovations and installation of fire sprinklers. There were two residents residing at the facility prior to the renovations. Two residents had agreed to relocate. One was placed at another facility operated by the LI and the other transferred to a different facility through the Assisted Living Waiver program. LI stated that the Department was not notified about the alterations made inside the facility and relocation of residents. At approximately 8:45am,Licensee arrive at the facility to assist with the Required 1 Year Inspection. LPA observed three old mattresses in the driveway. LPA Bentley contacted Licensee Mark Fisk arrived at the facility to assist. LPA conducted a tour of the facility and observed there were no residents/staff on site. LPA observed all floors throughout the facility were replaced and covered, and openings in the ceilings (with sprinkler piping exposed) throughout the facility were made for installation of fire suppression system. Facility is not accepting residents at this time. The annual licensing fee remains current with a balance of $0.

Licensee was advised on the following: to submit a written report of any major occurrences which threatens the health, safety, and welfare of residents within 24 hours, to notify the Department when renovations or alterations being made to the facility and upon completion and prior to admitting a new resident.

Based on the observations made during today's visit, a deficiency is being cited on the attached LIC9099D.
An exit interview was conducted with Licensee Mark Fisk, and a copy of this report, along with the LIC9099D, and the appeal rights were provided at exit.
NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Eboni Bentley
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2026
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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Document Has Been Signed on 02/13/2026 11:01 AM - It Cannot Be Edited


Created By: Eboni Bentley On 02/13/2026 at 10:17 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ARBOR VIEW
FACILITY NUMBER: 306002173

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/20/2026
Section Cited
CCR
87211(a)(2)

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87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department...: (2) Occurrences, such as..., catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours...to the licensing agency and to the local health officer when appropriate. This requirement was not met as evidenced by:
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Licensee stated they will provide a written incident report of the relocations and renovations, and Death Report for relocated resident by POC due date. Licensee will also submit an Acknowlegement of Understanding of the said deficiency that will be submitted to LPA via email by POC due date.
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Based on observations and interviews, the Department was not notified of the relocation of residents, renovations inside the facilty in February 2025, and the passing of relocated resident in June 2025, which poses a potential Health, Safety, or Personal Rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lourdes Montoya
NAME OF LICENSING PROGRAM MANAGER:
Eboni Bentley
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 02/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/13/2026


LIC809 (FAS) - (06/04)
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