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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004399
Report Date: 03/30/2026
Date Signed: 03/30/2026 12:04:05 PM

Document Has Been Signed on 03/30/2026 12:04 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:QUALITY SENIOR LIVINGFACILITY NUMBER:
306004399
ADMINISTRATOR/
DIRECTOR:		MARIA DOLORES D TENTEFACILITY TYPE:
740
ADDRESS:24262 GRASS STREETTELEPHONE:
(949) 215-3087
CITY:LAKE FORESTSTATE: CAZIP CODE:
92630
CAPACITY: 6CENSUS: DATE:
03/30/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:33 AM
MET WITH:Maria Tente (Administrator) TIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On today;s date, Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of conducting an annual inspection. Upon arrival LPA was greeted and granted entry to the facility by facility staff. LPA explained the nature of the visit, and Administrator (AD) Maria Tente was notified, and arrived shortly after to assist with the annual inspection. LPA began a tour accompanied with AD and observed the following. AD has a valid Administrator certificate that is valid from December 4, 2024 thought December 3, 2026

The facility is a two storied home with eight bedrooms, five of which are resident rooms, and three of which are staff rooms, five bathrooms two of which are private resident bathrooms, two of which are shard resident bathrooms, and one of which is a staff bathroom, and an attached two car garage. LPA observed the kiten area to be clean and free of any mildew. LPA observed there to be a refrigerator, microwave, gas stove, dishwasher, washer and a dryer in the facility. All appeared to be in good condition and tested operational. LPA observed a two day supply of perishable food, and a seven day supply of non-perishable food as well a sufficient amount of emergency water on hand.

LPA observed all resident rooms to be free of any hazards and debris. LPA observed all bedrooms to have all required furnishings including a bed, clean linens in good repair; meaning no strains or tares, a chest of drawers, a reading lamp, and enough storage for personal belongings. LPA observed resident bathrooms to be clean and free of any mildews and debris. Water faucets and toilets tested operational. Hot water temperature tested between 113.4 and 117.3 degrees Fahrenheit, grab bars, slip resistant floor matts and shower chair were observed to be in resident bathrooms. CONTINUED ON LIC809-C
NAME OF LICENSING PROGRAM MANAGER: Armando J Lucero
NAME OF LICENSING PROGRAM ANALYST: William Vanegas
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 03/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/30/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
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: QUALITY SENIOR LIVING
FACILITY NUMBER: 306004399
VISIT DATE: 03/30/2026
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LPA Vanegas observed all smoke detectors and carbon monoxide detectors to be operational. LPA Vanegas observed first aid kit to have all required items such as adhesive tape, scissors, tweezers, bandages, a thermometer, and a first aid manual. LPA observed fire extinguishers to no have a service tag, or a recent receipt attached to it, it was not made aware of it was recently purchased or serviced. A deficiency was issued on today's date.

LPA reviewed two resident files and two staff files. All files (staff and resident) were all up to date, and had required items. Staff training was not up to date and a deficiency was issued on today's date. LPA reviewed medications with AD and observed all medications to be documented correctly. Per LPA review medications are being administered per physicians orders.

LPA toured the outside of the facility and observed the outside of the facility to be clean and free of any hazards, and debris. LPA observed backyard of the facility to be large enough to participate in outdoor activities upon resident request. LPA observed an outdoor shaded sitting area, and a fully fenced pull with the fence measuring five ft tall, and gaps in between the railing measured to be four inches.

Based on today's observations deficiencies will be issued per title 22 Division 6 Chapter 8 of the California Code of Regulations. An exit interview was conduced with AD Maria Tente, 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: 03/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 03/30/2026 12:04 PM - It Cannot Be Edited


Created By: William Vanegas On 03/30/2026 at 10:56 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: QUALITY SENIOR LIVING
FACILITY NUMBER: 306004399

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87203
87203 Fire Saftey
All facilites shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above as fire extinguishers was observed to not have an updated service tag, or a recent purchase reciept which poses a potential safety risk to persons in care.
POC Due Date: 04/13/2026
Plan of Correction
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Administrator will schedule an appointment with fire department to have fire extinguishers serviced or purchase new fire extinguishers and send a receipt as proof to LPA prior to P.O.C due date.
Type B
Section Cited
CCR
87412(c)(2)
87412 Personnel Records
(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. (2) Documentation of staff training shall include: (A) Trainer’s full name; (B)Subject(s) covered in the training; (C) Date(s) of attendance; and (D) Number of training hours per subject

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in one of two staff records not having documented training. which poses a potential health and safety risk to persons in care.
POC Due Date: 04/13/2026
Plan of Correction
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Administrator will provide and document correct training for staff members and document them correctly. Administrator will send proof via email to LPA prior to P.O.C due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Armando J Lucero
NAME OF LICENSING PROGRAM MANAGER:
William Vanegas
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 03/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2026


LIC809 (FAS) - (06/04)
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