<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005909
Report Date: 02/20/2025
Date Signed: 02/20/2025 12:07:27 PM

Document Has Been Signed on 02/20/2025 12:07 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:TESSA'S PLACE 2FACILITY NUMBER:
306005909
ADMINISTRATOR/
DIRECTOR:		AVENDANO, ELEONORFACILITY TYPE:
740
ADDRESS:25321 DE SALLE DRIVETELEPHONE:
(949) 331-3822
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY: 6CENSUS: 6DATE:
02/20/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Mark Ryan Cruz- Administrator TIME VISIT/
INSPECTION COMPLETED:
12:25 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Ruth Martinez and Hanna Gough are conducting this unannounced visit for the purpose of completing the required annual inspection. LPAs arrived at the facility and was greeted and granted entry by staff. LPAs spoke with Mark Cruz, Administrator and explained the nature of the visit. There are six residents at the facility and there are two residents receiving hospice care.

LPAs began the tour of the facility. LPAs observed required department postings throughout the facility. Facility stays within the capacity limitations. There is a minimum of seven days of non-perishables foods and two days of perishables foods on hand. LPAs inspected the medication is centrally stored in a locked storage closet located in the hallway that leads to the bedrooms. LPAs reviewed medication and observed medication was labeled and stored inaccessible to residents in care. LPAs inspected the facility bathrooms and LPAs measured the hot water temperature between 106.8-119.8 degrees Fahrenheit. All bathrooms observed to have a supply of soap, toilet paper and paper towels. Bathrooms are equipped with required safety measures such as non-skid mats and grab bars. Lighting is sufficient to ensure safety and comfort. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPAs observed that toxic chemicals, cleaning solutions and disinfectants are stored locked in a storage cabinet located in the garage. The facility has an available clean supply of linens. LPAs inspected residents’ bedrooms which has sufficient lighting to ensure their safety and comfort. All bedrooms observed to have all required components and furnishings. Storage space is provided for residents in their bedrooms. Smoke and carbon monoxide detectors were tested and found to be operational. LPAs toured the outside of the facility and observed outdoor passageways are free of obstructions. LPAs observed there is shaded seating area for residents’ enjoyment. LPAs observed a fire extinguisher with a service date of March 05, 2024, in the dining room.

Continued on LIC809-C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/20/2025
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 2
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: TESSA'S PLACE 2
FACILITY NUMBER: 306005909
VISIT DATE: 02/20/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Fire drills are conducted quarterly with the last one being conducted on January 2, 2025. LPAs reviewed four resident records. All the required documentations were present and current in the residents’ files. LPAs reviewed two employee records. All employees present have a criminal record clearance and are associated to the facility and are CPR certified.

Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with the Administrator, and a copy of this report was provided to the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC809 (FAS) - (06/04)
Page: 2 of 2