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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006329
Report Date: 07/29/2024
Date Signed: 07/29/2024 01:02:22 PM

Document Has Been Signed on 07/29/2024 01:02 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:FLORESTA COTTAGEFACILITY NUMBER:
306006329
ADMINISTRATOR/
DIRECTOR:
MANIAGO, MARIE JOYCE M.FACILITY TYPE:
740
ADDRESS:26982 FLORESTA LANETELEPHONE:
(917) 386-5767
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 6CENSUS: 5DATE:
07/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Marie Maniago, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On this day, Licensing Program Analysts (LPA) Kevin Saborit-Guasch and William Vanegas made an unannounced visit to the facility for the purpose of conducting the Required Annual Inspection. LPAs were greeted and granted entry by facility caregiving staff after introducing themselves and stating the purpose of the inspection. Administrator Marie Maniago was notified of the visit by telephone and arriver later to assist.

During the inspection, LPAs and facility staff conducted a tour of the physical plant and observed the following: The facility is a one-story home with six private bedrooms and two bathrooms in addition to the facility's common living areas. All resident bedrooms have the required furnishing, bathrooms are equipped with grab bars and slip mats. LPA observed all beds have linens and blankets. The backyard has a shaded area and the routes of egress are free of clutter and obstructions. There are currently five residents admitted to the facility with one resident pending admission onto hospice care at the time of the visit. Residents are observed to be clean and appear well taken care of. Bathrooms faucets and toilets were operational. Water temperature was verified to be within slightly under acceptable range, technical advisory note issued. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. Fire drills are conducted quarterly. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required. Smoke and carbon monoxide detectors tested operational. One fire extinguisher present is observed to be fully charged with proof of up-to-date maintenance. Sharp items, cleaning supplies and medications were confirmed to be inaccessible throughout the physical plant. The medication central storage was also observed to be secure and was reviewed for accuracy during the visit. LPA reviewed five resident files along with four staff files. Two staff and two resident interviews were conducted.

Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report along with a technical assistance advisory note was left at the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 07/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2024
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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