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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005819
Report Date: 10/09/2025
Date Signed: 10/09/2025 05:13:37 PM

Document Has Been Signed on 10/09/2025 05:13 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:ORANGE POINT HOME CAREFACILITY NUMBER:
306005819
ADMINISTRATOR/
DIRECTOR:		LOMEDA, SHIRLEYFACILITY TYPE:
740
ADDRESS:6911 SAN JUAN CIRCLETELEPHONE:
(714) 886-2282
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 6DATE:
10/09/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Shirley Lomeda - AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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On October 9, 2025, Licensing Program Analyst (LPA) Eboni Bentley arrived at the facility for an unannounced, subsequent annual continuation visit. Upon arrival at the facility, LPA Bentley was greeted and granted entry into the facility by Administrator (AD), Shirley Lomeda and explained the purpose of the visit.

During the inspection, LPA Bentley toured the physical plant and the following was observed: All resident bedrooms had the necessary elements and were in compliance with regulation guidelines. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Resident and staff bathrooms were clean and organized. Hot water temperatures were measured in the range of 117.3 degrees Fahrenheit and 118.4 degrees Fahrenheit. All grab bars were tightly secured to the wall. Kitchen was inspected. Perishable and non-perishable food supply was observed. All appliances were observed working and operational. A perishable food supply that meets regulation requirements was observed in the refrigerator and a non-perishable food supply observed in the cabinets. During the tour, the garage was observed with three beds used for staff sleeping. LPA observed a emergency disaster kit with expired cans of non-perishable food items for residents and staff. There was a limited supply of emergency water available.

The backyard was clean and organized, however, the walkway leading to the exit side gate had a drainage pipe leaking water in its path. A shaded patio area with a table and chairs was observed with no hazards. There is a shed that is used to store miscellaneous facility items no longer being used, including walkers, a bed frame mattress and other items.

Continue to LIC809-C.....

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Eboni Bentley
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/09/2025
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: ORANGE POINT HOME CARE
FACILITY NUMBER: 306005819
VISIT DATE: 10/09/2025
NARRATIVE
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During the initial visit, a staff record review was completed for 4 staff members including Administrator Lomeda, 6 of 6 resident medications, and all 6 resident files were also reviewed. Record review revealed, five out of six resident (R1-R5) have Needs & Services appraisal that have not been updated within the past 12 months. LPA also noted five out of six residents (R1-R5) do not have physician's reports documented within the past 12 months. Three out of the five residents (R1, R4, & R5) have a diagnosis of Dementia.

LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. First aid kits had all the required elements including tweezers, thermometer, scissors, and manual. A working telephone (714-886-2061) remains available, and the facility has a device that can be used for video teleconference purposes. The facility has two (2) fire extinguisher that was charged and last serviced on September 19, 2025. Liability Insurance is effective July 26, 2025 through July 26, 2026.

Based on the observations made during today’s visit, deficiencies is being cited per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted, and a copy of this report, LIC809-D, LIC811 and appeal rights were provided to Administrator Shirley Lomeda at the end of the visit.

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Eboni Bentley
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 10/09/2025 05:13 PM - It Cannot Be Edited


Created By: Eboni Bentley On 10/09/2025 at 03:22 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: ORANGE POINT HOME CARE
FACILITY NUMBER: 306005819

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/09/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
87303(a)
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations and interview, the licensee did not comply with the section cited above, which poses a potential risk to residents in care. LPA observed a drainage pipe leaking water on the side of the house, into buckets. LPA also oberved a Urine smell in R3's room.
POC Due Date: 10/17/2025
Plan of Correction
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The licensee stated they will redirect drainage from leaking pipe to drain in near by grass to remove obstruction of exit gate pathway. Licensee stated they will conduct a deep cleaning of R3's room to ensure removal of urine odor and submit proof to CCLD via email by POC due date.
Type B
Section Cited
CCR
87307(d)(2)
(2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations and interview, the licensee did not comply with the section cited above, which poses a potential risk to residents in care. During tour, LPA observed three beds in garage, lying flat on the ground with fitted sheets. Administrator stated staff sleeps in garage but primarily sleeps on couch and futon in common areas of the house as it is more comfortable.
POC Due Date: 10/17/2025
Plan of Correction
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The licensee stated they will remove beds from garage and ensure staff are no longer sleeping in common areas of the facility. Licensee stated they will submit proof to CCLD via email by 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.
Lourdes Montoya
NAME OF LICENSING PROGRAM MANAGER:
Eboni Bentley
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/09/2025


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 10/09/2025 05:13 PM - It Cannot Be Edited


Created By: Eboni Bentley On 10/09/2025 at 03:22 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: ORANGE POINT HOME CARE
FACILITY NUMBER: 306005819

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/09/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87468.2(a)
(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations and interview, the licensee did not comply with the section cited above, which poses a potential risk to residents in care. LPA observed a camera on in R3's bedroom and a monitor displaying live video of residents bed and bedroom. Administrator stated camera was installed at the request of R3's family upon move in but did not have any signed documentation of CCL approval. Administrator stated they did not initially submit a letter to the department requesting approval of camera in private resident bedroom. Record review revealed, the facility did not reference the camera in the signed admissions agreement.
POC Due Date: 10/17/2025
Plan of Correction
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The licensee stated they will either remove the camera from R3's bedroom and submit proof to CCLD via email by POC due date, or send a formal letter to CCLD requesting approval of camera with supporting documentation attached.
Type B
Section Cited
CCR
87463(h)
(h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview, the licensee did not comply with the section cited above, which poses a potential risk to residents in care. Record review revealed five out of six resident (R1-R5) have Needs & Services appraisal that have not been updated within the past 12 months. LPA also noted five out of six residents (R1-R5) do not have physician's reports documented within the past 12 months. Three out of the five residents (R1, R4, & R5) have a diagnosis of Dementia.
POC Due Date: 10/17/2025
Plan of Correction
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The licensee stated they will obtain updated physician's report for residents mentioned above and create current Needs & Services Appraisals based on those medical assessments. Licensee stated they will review Needs & Services Appraisals with R1-R-5's responsible persons and submit proof to CCLD via email by 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.
Lourdes Montoya
NAME OF LICENSING PROGRAM MANAGER:
Eboni Bentley
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/09/2025


LIC809 (FAS) - (06/04)
Page: 5 of 6
Document Has Been Signed on 10/09/2025 05:13 PM - It Cannot Be Edited


Created By: Eboni Bentley On 10/09/2025 at 03:29 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: ORANGE POINT HOME CARE
FACILITY NUMBER: 306005819

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/09/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.695(a)(2)
(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 observations and interview, the licensee did not comply with the section cited about, which poses a potential risk to residents in care. LPA observed a half case of individual bottled water and expired cans of food stored in the garage. Admiistrator stated they will buy additional cases of water and canned goods to replace the expired items.
POC Due Date: 10/17/2025
Plan of Correction
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The licensee will purchase additional cases of water and canned goods to replace the expired items and submit proof to CCLD via email by POC due date.
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.
Lourdes Montoya
NAME OF LICENSING PROGRAM MANAGER:
Eboni Bentley
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/09/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/09/2025


LIC809 (FAS) - (06/04)
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