Senior Care Records.

Facility Evaluation Report

Good Samaritan Guest Home III, Mission Viejo05/31/2022Licence 306000692

Capacity5
Census4
Date signed05/31/2022 04:24:13 PM
The inspector’s account

On 05/31/2022 at 3:30pm, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility in order to conduct a required annual inspection. LPA arrived at facility, was greeted and granted entry by Leonardo Cambio, Administrator after explaining the purpose of the visit. LPA observed a check-in station in proximity to the facility entry point used for visitors.

At approximately 3:50pm, LPA accompanied by administrator toured the inside and outside of the facility. There are currently four (4) residents in care. Residents are observed relaxing in the common areas or in their bedroom and appear clean and well taken care of. The three (3) bedrooms include all necessary components. The bathrooms are equipped with grab bars and slip mats. Facility is clean, sanitary and free of odors in all areas inspected.

Sharp instruments are stored in a kitchen cabinet with a key lock. LPA observed a sufficient supply of food and water. A 30-day supply of medication is centrally stored and locked in a cabinet. Cleaning supplies are secured in the locked attached garage and laundry room. A Technical Advisory is however issued in regard to cleaning supplies being stored in the shared bathrooms and unlocked staff bedroom. An ample supply of linen is observed also. LPA observed the facility has COVID-19 Precautions and required department postings. Facility has an adequate supply of PPE. LIC808 Mitigation Plan has been submitted. Staff present is adequately cleared in Guardian.

LPA toured the outside of the facility and observed it to be free of obstructions. LPA observes a shaded area with patio furniture used by residents and visitors. The perimeter gate is self-latching and can easily be opened in an evacuation. There are no bodies of water on the premises

Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with facility representative and a copy of this report was provided and left at facility.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction