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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006273
Report Date: 06/19/2024
Date Signed: 06/19/2024 11:55:49 AM

Document Has Been Signed on 06/19/2024 11:55 AM - 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:EPIC ASSISTANCE CARE HOME #2FACILITY NUMBER:
306006273
ADMINISTRATOR/
DIRECTOR:
MESDJIAN, LIZAFACILITY TYPE:
740
ADDRESS:25464 VIA ESTUDIOTELEPHONE:
(949) 218-7268
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY: 6CENSUS: 6DATE:
06/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Liza MesdjianTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection. LPA met with staff and explained the reason for the visit. The Administrator, Liza Mesdjian's Administrator's certificate expires on July 29, 2024. LPA and the Administrator toured the facility. LPA observed the See Something, Say Something poster (PUB 475) posted in the entry way of the facility. The facility is a single story home with 6 bedrooms, 4 bathrooms, living room, dining room, kitchen and a 2 car garage. LPA observed the fireplace in the living room is screened. LPA toured the kitchen and dining room. The kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. The 4 burner gas stove lights unassisted. LPA observed the knives are kept locked in a kitchen drawer. LPA observed the fire extinguisher in the dining room is fully charged. LPA toured the resident rooms. LPA observed all resident rooms are clean and organized. All resident beds had the required linens. LPA observed all 4 bathrooms are clean and operational. How water measured 105.0 degrees Fahrenheit in all 4 bathrooms. LPA toured the garage. The garage is used for storage and kept locked. LPA observed extra furniture, supplies and perishable food stored in the garage refrigerator. The living room has chairs for residents to sit and there is a TV mounted above the fireplace for residents to watch TV. LPA observed reading material and games stored in the hall closet off the dining room next to bedroom number 6. LPA observed the medication is stored in the locked closet next to bedroom number 2. At 10:30 am the Administrator arrived. LPA toured the backyard. LPA observed a covered patio in the backyard. No bodies of water observed. The exit gate is operational and is self closing. There is a courtyard at the front of the house that has a seating area with shade so the residents can sit outside. No obstacles or hazards observed inside or outside of the facility. LPA reviewed 4 staff files, no discrepancies observed. The 4 staff had the required 20 hours of annual training. LPA reviewed 6 resident files and medications, no discrepancies observed. Smoke detectors and the carbon monoxide detectors tested operational. LPA inspected the first-aid kit. The first-aid kit had all the required elements. No deficiencies observed during the visit. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2024
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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