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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006047
Report Date: 01/30/2025
Date Signed: 01/30/2025 05:06:59 PM

Document Has Been Signed on 01/30/2025 05:06 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:KNOTT'S LANDING LUXURY CAREFACILITY NUMBER:
306006047
ADMINISTRATOR/
DIRECTOR:		RAJPOOT, FAISALFACILITY TYPE:
740
ADDRESS:6359 ARNOLD WAYTELEPHONE:
(714) 735-8972
CITY:BUENA PARKSTATE: CAZIP CODE:
90620
CAPACITY: 6CENSUS: 6DATE:
01/30/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Victoria Paul - AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On January 30, 2025, Licensing Program Analyst (LPA) Eboni Bentley arrived at the facility unannounced, for the purpose of conducting a required annual visit using the CARE Inspection Tool. LPA Bentley was greeted, granted entry by staff, and explained the reason for the visit. Staff called the Administrator (AD) Victoria Paul via telephone who arrived a short time later and was present for the visit. AD Paul has a current Administrator Certificate with an expiration date of March 24, 2026. Administrator Faisal Rajpoot later arrived to close out visit.

Knott’s Landing Luxury Care is a one story community with three (3) resident bedrooms, one (1) staff bedroom and two (2) bathrooms. The facility is licensed for six (6) non-ambulatory residents with an approved hospice waiver for six (6) residents. Currently, there are six (6) residents on census of which one (1) is receiving hospice care. All six (6) residents were present during today’s visit. Residents were observed in the living room exercising, in the dining room eating, and later participating in activities.

At 9:00AM, LPA Bentley conducted a tour of the physical plant accompanied by AD Paul and the following was observed: There were no bodies of water on the premises, all rooms were inspected, beds and bedding supplies were available, lighting was provided in all rooms, and storage for the residents’ personal belongings were observed in residents’ closets. Additional bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperatures measured at 116.6 and 117.5 degrees F. in bathrooms throughout the facility.

All resident bedrooms were clean, well-organized, and had all necessary items and storage space. The kitchen was clean and organized. All knives and sharp objects were locked in a cabinet near the stove. A two day supply of perishable food items and seven day supply of nonperishable food items was observed.

Continued on LIC809C
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE: DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/30/2025
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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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: KNOTT'S LANDING LUXURY CARE
FACILITY NUMBER: 306006047
VISIT DATE: 01/30/2025
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In the kitchen, was a locked file cabinet with resident files. LPA Bentley observed a first aid kit with all the required elements. Two (2) fully charged fire extinguisher were observed mounted with a last service date of December 23, 2024. Smoke detectors were tested and operational. The last fire and disaster drill was conducted on January 6, 2025.

The garage was clean and walkways were free of clutter and debris. A refrigerator with a supply of perishable items was observed and a washer and dryer were found in working condition. The backyard was clean and free of clutter and debris. The side exit gates were clear and accessible. A shaded patio area with tables and seating were observed. Two (2) storage sheds were also observed in the back yard, right next to each, with one containing nonperishable and emergency food supply. The facility has and adequate amount of emergency food and water supply.

A review of six residents (R1-R6) service files and six (6) staff (S1-S6) personnel files revealed to be complete. Six (6) resident interviews and three (3) staff interviews were conducted during today's visit.

The facility has liability insurance on file effective May 17, 2024 through May 17, 2025. A review of the medication and Medication Records Administration (MAR) was conducted, and a technical advisory was issued.

No deficiencies were cited during today’s inspection visit.

An exit interview conducted and a copy of the report was provided to Administrator Faisal Rajpoot.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2025
LIC809 (FAS) - (06/04)
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