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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004793
Report Date: 07/21/2025
Date Signed: 07/21/2025 05:03:09 PM

Document Has Been Signed on 07/21/2025 05:03 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:SEASONS AT LAGUNA - 2FACILITY NUMBER:
306004793
ADMINISTRATOR/
DIRECTOR:		MARICEL GUIDILONDOFACILITY TYPE:
740
ADDRESS:28961 PASEO DE OCASOTELEPHONE:
(949) 340-6688
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY: 6CENSUS: 6DATE:
07/21/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Hannah PichonTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted by staff and granted entry. LPA met with Administrator Hannah Pichon and explained the reason for the visit. Hannah Pichon's Administrator's Certificate expires on December 18, 2026. Facility is licensed for 6 non-ambulatory residents of which 6 can be bedridden and a hospice waiver for 3. LPA and staff toured the facility. LPA observed all six 6 resident rooms have the required furnishings. LPA observed clean linens stored in the hall closet. LPA observed all 5 bathrooms are clean and operational. Hot water measured 120.0 degrees Fahrenheit in both (2) shared bathrooms. Medications are kept locked in the hall closet. LPA observed medication for all 6 residents, for July 21 and July 22 (AM medications only) stored in plastic cups, staff reported that the medication stored in the plastic cups are going to be administered later today and tomorrow morning July 22, 2025. LPA observed medications (for all 6 residents) for July 23 and the rest of July are stored in their original containers. LPA inspected the first aid kit. The First aid kit has all the required elements. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed knives are kept locked under the kitchen sink. The 4 burner gas stove lights unassisted. There is no record of a recent emergency drill being conducted in the last 4 months. Smoke detectors/carbon monoxide detectors tested operational except for the smoke detector/carbon monoxide detector in the hallway between bedroom 5 and bedroom 6. LPA observed the garage is used for storage of cleaning supplies and old furniture. LPA observed the lock on the garage door knob is not operational. LPA observed and staff verified there is no 3 day emergency food and water supply at the facility. LPA and staff toured the backyard. No bodies of water observed. There is a covered patio with a shaded seating area for residents to sit outside. Both exit gates are operational and self closing. LPA reviewed 6 resident files, no discrepancies observed. LPA reviewed 6 resident medications, no discrepancies observed.
NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Joseph Alejandre
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2025
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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Document Has Been Signed on 07/21/2025 05:03 PM - It Cannot Be Edited


Created By: Joseph Alejandre On 07/21/2025 at 04:11 PM
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: SEASONS AT LAGUNA - 2
FACILITY NUMBER: 306004793

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1569.695(a)(2)
Other Provisions
(a)In addition to any other requirement of this chapter, a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: (2) Plans for the facility to be self-reliant for a period of not less than 72 hours immediately following any emergency or disaster, including, but not limited to, a short-term or long-term power failure. If the facility plans to shelter in place and one or more utilities, including water, sewer, gas, or electricity, is not available, the facility shall have a plan and supplies available to provide alternative resources during an outage.

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, LPA observed and staff verified the facility does not have a 3 day supply of emergency food and water] which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/22/2025
Plan of Correction
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Licensee agrees to have an emergency supply of food and water for the facility in compliance with HSC 1569.695(a)(2). Licensee to forward proof of correction to LPA by POD due date.
Type A
Section Cited
HSC
1569.695(c)
Other Provisions
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill.

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, there is no documented evidence of a recent emergency drill in the last 4 months, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/22/2025
Plan of Correction
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Licensee agrees to conduct an emergency drill in compliance with HSC 1569.695(c) and to submit proof of the completed emergency drill to the LPA by the POC 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.
Sheila Santos
NAME OF LICENSING PROGRAM MANAGER:
Joseph Alejandre
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/21/2025 05:03 PM - It Cannot Be Edited


Created By: Joseph Alejandre On 07/21/2025 at 04:11 PM
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: SEASONS AT LAGUNA - 2
FACILITY NUMBER: 306004793

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.625(b)(2)
Other Provisions
(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
Plan of Correction
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Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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.
Sheila Santos
NAME OF LICENSING PROGRAM MANAGER:
Joseph Alejandre
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/21/2025 05:03 PM - It Cannot Be Edited


Created By: Joseph Alejandre On 07/21/2025 at 04:34 PM
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: SEASONS AT LAGUNA - 2
FACILITY NUMBER: 306004793

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87203
All facilities 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, LPA observed the smoke detector/carbon monoxide detector in the hallway between bedroom 5 and bedroom 6 is not operational, which poses an immediate health and safety risk to persons in care.
POC Due Date: 07/22/2025
Plan of Correction
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Licensee agrees to replace the inoperative smoke detector by the POC due date. Licensee to submit proof of correction to LPA.
Type A
Section Cited
CCR
87465(h)(5)
Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.

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 LPA observed all 6 residents had their morning medications for July 22, 2025, stored in plastic cups, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/22/2025
Plan of Correction
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Licensee agrees to, not store resident medication in plastic cups prior to administering. Licensee agrees to keep all resident medications in it's original container until it is administered. Licensee agrees to sign a statement of understanding for CCR 87465 and to train all staff on CCR 87465. Licensee to submit the statement of understanding and proof of staff training to LPA by the POC 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.
Sheila Santos
NAME OF LICENSING PROGRAM MANAGER:
Joseph Alejandre
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2025


LIC809 (FAS) - (06/04)
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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: SEASONS AT LAGUNA - 2
FACILITY NUMBER: 306004793
VISIT DATE: 07/21/2025
NARRATIVE
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 LPA reviewed 2 staff files. LPA observed Staff 2 (S2) did not have any annual training covering, hospice care, postural supports and restricted health conditions. No obstacles or hazards observed inside or outside of the facility. Deficiencies are being cited (see LIC809Ds) per Title 22, Division 6 of the California Code of Regulations. Civil penalties assessed, see LIC421IM and LIC421FC. An exit interview was conducted and a copy of the report was provided along with appeal rights.
NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Joseph Alejandre
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025
LIC809 (FAS) - (06/04)
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