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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004745
Report Date: 08/29/2024
Date Signed: 08/29/2024 01:09:31 PM

Document Has Been Signed on 08/29/2024 01:09 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:LOTUS SENIOR CARE, HUNTINGTON BEACH IIIFACILITY NUMBER:
306004745
ADMINISTRATOR/
DIRECTOR:
RITA LEEFACILITY TYPE:
740
ADDRESS:6082 KENDRICK CIRCLETELEPHONE:
(949) 636-8007
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY: 6CENSUS: 4DATE:
08/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:25 PM
MET WITH:Administrator, Rita LeeTIME VISIT/
INSPECTION COMPLETED:
01:15 PM
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On 8/29/2024, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility for a required annual inspection. LPA was greeted and granted entry by Caregiver, Eduardo Diaz who was informed of the purpose of the visit. Administrator, Rita Lee arrived during the visit and was also informed of the purpose of LPA's visit. The facility has a fire clearance for six (6) non-ambulatory elderly residents, of which one (1) may be bedridden. The facility also has an approved hospice waiver for four (4) and LPA was informed there are two (2) residents currently receiving hospice services at the facility.

LPA toured the facility with Caregiver, Evelyn Deldio and observed the facility is made up of a two-story home with four (4) resident bedrooms, three (3) bathrooms, three (3) staff rooms, a kitchen, dining room, living room and attached garage. During the tour, Caregiver Diaz tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA observed charged fire extinguishers mounted throughout the facility. Indoor and outdoor passageways were free of obstruction. The facility has several outdoor shaded seating areas for the residents in care. There were no bodies of water observed on the premises. Medications are secured in a locked kitchen cabinet. Resident bedrooms had the required furniture and lighting. Resident bathrooms had grab bars near the toilets and in the showers. The facility had more than a 2-day supply of perishable foods and 7-day supply of non-perishable food items. LPA reviewed random resident and staff files. Resident files reviewed had signed admission agreements and residents with a dementia diagnosis had updated physician's reports. Staff present have a criminal record clearance and valid first aid/CPR certification.

During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted where a copy of this report was reviewed and provided to Administrator Lee.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2024
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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