306006249-2-12-2026-22-AS-JALE-DR925J-20260212160538

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006249
Report Date: 02/12/2026
Date Signed: 02/12/2026 04:05:52 PM

Document Has Been Signed on 02/12/2026 04:05 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:	OC HOME OF LAGUNA NIGUEL		FACILITY NUMBER:	306006249
ADMINISTRATOR/ DIRECTOR:	ANGELES, LOIDA		FACILITY TYPE:	740
ADDRESS:	23962 HILLHURST DRIVE		TELEPHONE:	(949) 202-8908
CITY:	LAGUNA NIGUEL	STATE: CA	ZIP CODE:	92677
CAPACITY: 6		CENSUS: 5	DATE:	02/12/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:55 PM
MET WITH:	Rachel Tutop		TIME VISIT/ INSPECTION COMPLETED:	04:30 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 Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by staff. LPA met with Assistant Administrator Rachel Tutop. and explained the reason for the visit. The Administrator's, Loida Angeles, Administrator's Certificate, expires on March 29, 2026. The facility is licensed for 6 residents of which 4 can be non-ambulatory and approved for 1 bedridden (bedroom 2) and a hospice waiver for 3. 5 residents were present at the time of the visit and 3 are on hospice. LPA and the Administrator toured the facility. Facility is a single story house with 7 bedrooms (1 bedroom is for staff), 5 bathrooms, kitchen/dining room, living room and a 2 car garage that is being used for storage. LPA observed the See Something, Say Something sign (PUB 475) posted on the kitchen wall. LPA observed all resident bedrooms have the required furnishings. LPA observed extra linens stored in the hall closet. LPA observed all the bathrooms are clean and operational. Hot water measured 115.1 to 116.0 degrees Fahrenheit in all bathrooms. Smoke detectors and carbon monoxide detectors tested operational. LPA observed the fireplace in the living room is screened and needs a key to operate, the key is kept locked. LPA observed the fire extinguisher in the dining room is fully charged. LPA observed a 2 day perishable and a 7 day non-perishable food supply in the kitchen. Knives are kept locked in a kitchen drawer. Medication is kept locked in a dining room cabinet. The kitchen is clean and organized. LPA observed the right front burner of the 5 burner gas stove does not light. The garage is kept locked and used for storage. LPA observed old furniture stored in the garage. LPA and staff toured the backyard. No bodies of water observed. There is a table with 4 chairs and an umbrella for residents to sit outside. No obstacles or hazards observed in the backyard. LPA reviewed reviewed 5 resident files and medications, no discrepancies observed. The facility has a laptop computer with internet access for resident use only.

NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Joseph Alejandre
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026

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: OC HOME OF LAGUNA NIGUEL	FACILITY NUMBER: 306006249
	VISIT DATE: 02/12/2026

NARRATIVE

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The last emergency drill was conducted on January 15, 2026. LPA reviewed 2 staff files. Both staff members have the required training including CPR/First Aid training. All staff present at the facility are background cleared and associated to the facility. LPA inspected the first aid kit. The first aid kit has all the required elements. LPA consulted with staff regarding reporting requirements. Deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted with the facility representative and a copy of the report provided along with appeal rights.

NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Joseph Alejandre
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/12/2026 04:05 PM - It Cannot Be Edited

Created By: Joseph Alejandre On 02/12/2026 at 03:42 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: OC HOME OF LAGUNA NIGUEL	FACILITY NUMBER: 306006249
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/12/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87303(a)

Maintenance and Operation

(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
1 2 3 4	Based on observation, the licensee did not comply with the section cited above, LPA observed the right front burner of the 5 burner gas stove does not light, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/25/2026
	Plan of Correction
1 2 3 4	Licensee agrees to fix the right front burner of the 5 burner gas stove so it can light unassisted. Licensee to forward proof of POC by the due date listed above.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 02/12/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2026

LIC809 (FAS) - (06/04)

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