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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006532
Report Date: 09/05/2026
Date Signed: 09/05/2026 09:34:32 AM

Document Has Been Signed on 09/05/2026 09:34 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:JUST LIKE YOUR ARE HOME 2FACILITY NUMBER:
306006532
ADMINISTRATOR/
DIRECTOR:		REROMA STEVELYNFACILITY TYPE:
740
ADDRESS:10265 SHERWOOD CIRCLETELEPHONE:
(714) 202-5154
CITY:VILLA PARKSTATE: CAZIP CODE:
92861
CAPACITY: 6CENSUS: 6DATE:
09/05/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Administrator Alicia LiraTIME VISIT/
INSPECTION COMPLETED:
09:30 AM
NARRATIVE
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On September 5, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct a Case Management - Deficiencies visit. Administrator (AD) Alicia Lira was present and assisted on today's visit.

This visit is being conducted in conjunction with complaint control 22-AS-20260319142233. During the investigation, the Department conducted a file review for Resident #1 (R1). The Department observed that R1 was admitted to the facility on May 17, 2025. R1 resided at the facility until February 16, 2026, when they were hospitalized and did not return to the facility afterwards. The Department reviewed R1’s Physician’s Report dated May 9, 2025, which stated that R1 required continuous bed care and was bedridden. The Department reviewed additional records for R1 including Per R1’s Preplacement Appraisal Information, Reappraisal, and Appraisal/Needs and Services Plan dated May 17, 2025. The records support that R1 was bedridden and required full assistance with activities of daily living (ADLs), such as transferring, bathing, toileting, and with medication. The Department reviewed the facility’s fire clearance and observed that they are only approved for six non-ambulatory residents and that they are not approved for any bedridden residents. Therefore, the facility violated their fire clearance by retaining R1, who was bedridden, between the dated of May 17, 2025, and February 16, 2026. During the investigation, the Department observed that the facility first observed a change of condition in R1 on December 2, 2025, due to R1 developing redness in their tailbone area. Despite the change in condition, the facility did not update R1’s Reappraisal to address this new condition. The Department also learned that the facility did not communicate with R1’s responsible party, or their primary care physician, regarding the change of condition until January 21, 2026.

CONTINUED ON LIC809-C

Sheila Santos
Brandon Lopez
DATE: 09/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
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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Document Has Been Signed on 09/05/2026 09:34 AM - It Cannot Be Edited


Created By: Brandon Lopez On 09/05/2026 at 08:43 AM
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: JUST LIKE YOUR ARE HOME 2
FACILITY NUMBER: 306006532

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/05/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/06/2026
Section Cited
CCR
87202(a)

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87202 Fire Clearance: (a) All facilities shall maintain a fire clearance ...Prior to accepting or retaining any of the following types of persons, the applicant.. shall ... obtain an appropriate fire clearance approved by the city, county,..
This requirement is not evidenced by:
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The Administrator stated that they will complete a statement of understanding regarding the regulation cited and will apply for an updated fire clearance. The Administrator agreed to provide LPA the statement of understanding and the following documents: Written letter requesting a
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Based on records reviewed, the Licensee did not adhere to their fire clearance as they retained a resident who was bedridden between May 17, 2025, and February 16, 2026, when they are not approved for a bedridden resident. This posed an immediate health and safety risk to persons in care.
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bedridden resident, a completed LIC200, and a completed LIC999. The Administrator agreed to provide the statement and documents via email or fax by POC due date.
Type B
09/14/2026
Section Cited
CCR87463(a)

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87463 Reappraisal:(a)The pre-admission appraisal... shall be updated in writing as frequently as necessary... to note significant changes in condition ..., the updated pre-admission appraisal shall be referred to as the reappraisal.
This requirement is not evidenced by:
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The Administrator stated that they will complete a statement of understanding regarding the regulation cited and will provide a written plan as to how they will prevent this incident from reoccurring. The Administrator agreed to provide LPA the statement and plan via email or fax by POC due date.
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Based on records reviewed, the Licensee did not update R1’s Reappraisal after they noted a change in their condition due to pressure ulcers developing on December 2, 2025. This posed a potential health and safety risk to persons in care.
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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:
Brandon Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/05/2026 09:34 AM - It Cannot Be Edited


Created By: Brandon Lopez On 09/05/2026 at 08:55 AM
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: JUST LIKE YOUR ARE HOME 2
FACILITY NUMBER: 306006532

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/05/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/14/2026
Section Cited
CCR
87466

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87466 Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes... the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's person responsible, if any.
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The Administrator stated that they will complete a statement of understanding regarding the regulation cited and will provide a written plan as to how they will prevent this incident from reoccurring. The Administrator agreed to provide LPA the statement and plan via email or fax by POC due date.
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This requirement is not evidenced by: Based on records reviewed & interviews conducted, the Licensee did not notify R1’s responsible party, or physician, after they noticed a change in condition on 12/2/25. This posed a potential health, safety, & personal rights risk to persons in care.
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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:
Brandon Lopez
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2026


LIC809 (FAS) - (06/04)
Page: 4 of 5
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: JUST LIKE YOUR ARE HOME 2
FACILITY NUMBER: 306006532
VISIT DATE: 09/05/2026
NARRATIVE
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Based on the information gathered, deficiencies are being cited on the attached LIC809-D pages. An immediate civil penalty in the amount of $500.00 is also being issued on the attached LIC421IM page. An exit interview was conducted with Administrator Alicia Lira. A copy of the report and appeal rights were provided at time of visit.
NAME OF LICENSING PROGRAM MANAGER: Sheila Santos
NAME OF LICENSING PROGRAM ANALYST: Brandon Lopez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2026
LIC809 (FAS) - (06/04)
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