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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003905
Report Date: 09/25/2025
Date Signed: 09/25/2025 09:28:06 AM

Document Has Been Signed on 09/25/2025 09:28 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:AEGIS ASSISTED LIVING OF LAGUNA NIGUELFACILITY NUMBER:
306003905
ADMINISTRATOR/
DIRECTOR:		KURT KNAUERFACILITY TYPE:
740
ADDRESS:32170 NIGUEL ROADTELEPHONE:
(949) 496-8080
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY: 96CENSUS: 71DATE:
09/25/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:21 AM
MET WITH:Kurt Knauer, General ManagerTIME VISIT/
INSPECTION COMPLETED:
09:45 AM
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Licensing Program Analyst (LPA) Rose Ruppert conducted an unannounced case management visit to deliver findings on an investigation completed by the Department. LPA was greeted and granted entry into the facility by the Concierge and explained the purpose of the visit.

During the Department’s investigation for complaint control # 22-AS-20250218081, the following was discovered:

Resident #1 (R1) was admitted to the facility on November 24, 2022, and resided in Memory Care. Per Physician report dated October 31, 2024, R1 had a diagnosis of Hydronephrosis with renal and ureteral calculous obstruction, sepsis and Mild Cognitive Impairment. Physician report further assessed R1 was non-ambulatory and a maximum assist for all self-care needs and activities of daily living.

On December 4, 2024, facility progress notes document that, “the resident’s left heel is noted with a small purple/red discoloration non-blanchable. The care team was instructed to reposition resident every two hours, elevate the resident’s legs and support R1’s heels with a pillow for support.” LPA spoke with Health Service Director if facility has a log that tracks how often a resident is turned. The facility currently does have a log to track frequency of turning of residents.

On December 5, 2025, facility progress notes by LVN at 8:04pm document, “Pt noted to have unstageable wound on Left heel.” Care staff continue to observe the unstageable pressure injury in the progress notes and applied foam dressing and wound care. On January 16, 2025 Home Health delivered heel protectors to apply in heels daily.

(Continued on LIC 809-C)

NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: RoseMarie Ruppert
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2025
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: AEGIS ASSISTED LIVING OF LAGUNA NIGUEL
FACILITY NUMBER: 306003905
VISIT DATE: 09/25/2025
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(Continued from LIC 809)

Home Health Notes from January 29, 2025, documented a large eschar on the left heel of R1 and an appointment was scheduled with Primary Care Physician at 3:30pm. R1’s Power of Attorney (POA) was notified. Physician addressed pressure ulcer of left heel, unstageable pressure injury and gave a referral order for hospice. Home Health notes confirm this diagnosis and nurse applied Betadine to the area on February 1, 2025.

R1 was sent out to the hospital on February 5, 2025, for further evaluation of a urethral rupture and Urinary Tract infection. R1 returned to the facility on February 6, 2025, at 12:30am with antibiotics. On February 10, 2025, R1 is noted with a pressure injury on the right hip, as well as the unstageable wound on left heel. General Manager (GM) and nurse spoke with POA about wound concerns and R1 was transported to Emergency Room for further evaluation.

Facility Progress notes dated on February 18, 2025, document that POA spoke with GM and reported R1 was in a Skilled Nursing Facility (SNF) and would be discharged from Aegis Senior Living.

Based on Department record review and interviews, it is determined that Resident #1 (R1) was diagnosed with an unstageable pressure injury on R1’s left heel on December 5, 2024. The facility retained the resident with a prohibited health condition until February 10, 2025.

The following is being cited per California Code of Regulations, Title 22.

A Civil Penalty is pending determination by Community Care Licensing Division as per Health & Safety Code 1569.49 (f)

An exit interview was conducted with Kurt Knauer, General Manager, and a copy of this report, the LIC 809-D, the LIC 421IM and Appeal Rights were provided to the facility.

NAME OF LICENSING PROGRAM MANAGER: Alisa Ortiz
NAME OF LICENSING PROGRAM ANALYST: RoseMarie Ruppert
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/25/2025 09:28 AM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: RoseMarie Ruppert On 09/25/2025 at 08:53 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: AEGIS ASSISTED LIVING OF LAGUNA NIGUEL
FACILITY NUMBER: 306003905

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
09/26/2025
Section Cited
CCR
87615(a)(1)

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87615 Prohibited Health Conditions (a) Persons who require health services for or have a health condition...shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement is not met as evidenced by: Based on Department
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General Manager (GM) will speak with VP of Nursing and Nursting staff to provide staff-inservice on Prohibited Conditions; which include Pressure Injuries. GM will email LPA documentation of inservices by end of business 9/27/2025.
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record review and interviews Resident #1 (R1) was documented to have an unstageable pressure injury on 12/5/24, which is a prohibited condition, and remained in the facility until 2/10/25. This poses an immediate health and safety risk to the resident 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.
Alisa Ortiz
NAME OF LICENSING PROGRAM MANAGER:
RoseMarie Ruppert
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2025


LIC809 (FAS) - (06/04)
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