Facility Evaluation Report, 09/13/2022 — Pacifica Cottage, Mission Viejo CA

On 09/13/2022, Licensing Program Analyst (LPA) Jessica Cho conducted an unannounced visit to Pacifica Cottage. The purpose of today's visit was to conduct a Required 1 Year focusing primarily on the Infection Control. At 9:29am, LPA Cho was allowed entry into the facility and met with Caregiver Bryan Bernadino after completing the Coronavirus 2019 (COVID-19) screening procedure. Lead Caregiver Maria Villanueva was also present at this time. At 9:35am, LPA spoke to House Manager (HM) Jocelyn Tolentino via a telephone call and stated the purpose of today's visit. As of today, there are no active COVID-19 cases in the facility. Facility screens and documents temperatures for visitors on a sign in sheet. LPA observed the required COVID-19 precautionary signs posted on the front door and throughout the facility. LPA observed the Complaint Poster (PUB475) in the size of 8.5"x11" which did not meet the size requirement. The facility is licensed for six non-ambulatory residents of which one may be bedridden and has a hospice waiver for six. There are currently six residents living in the facility of which one is receiving hospice care. The Administrator's Certificate for Muqueet Dadaboy expires on 03/27/23.

At 9:40am, LPA Cho conducted a tour of the physical plant along with Caregiver Villanueva. The single story home consists of six resident bedrooms and five resident bathrooms. There is one guest bathroom. The facility also has a family room, living room, dining area, kitchen, laundry area, and an attached two car garage. The resident bedrooms had the required furnishings, bed linens, and closet/drawer space to accommodate each resident comfortably. LPA observed a camera in the bedrooms of R1 and R2, and the cameras were immediately removed during the visit. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, showers were free of mold/mildew, and non-skid mats were in place. Resident bath towels and personal hygiene supplies were adequately stocked including paper towels and hand soaps. LPA observed hand washing signs in all bathrooms.