Complaint
Allegations0 substantiated · 2 unsubstantiated · 0 unfounded
No deficiencies recorded in this reportPATCHWORK QUILT GUEST HOME II
25182 CAMPO ROJO, Lake Forest CA 92630
6 bedsLatest official report Apr 23, 2026Licensed
Additional info
- Telephone
- (949) 581-7049
- Licensee
- TRIPLE K SENIOR SERVICES, INC.
- Administrator
- RIZALINA S. REYES
- Contact
- RIZALINA S. REYES
- License first date
- Mar 29, 2004
- License effective date
- Mar 29, 2004
- District office
- ORANGE COUNTY RO · (714) 703-2840
- Regional office
- 22
- Clients served
- 983 - RCFE / DEMENTIA
Summary
The available records show 3 Type A and 4 Type B deficiencies for this facility.
- Most recent inspection
- Mar 24, 2026
- Most recent deficiency
- Mar 6, 2025
2 later reports, from Mar 24, 2026 through Apr 23, 2026, recorded no deficiencies, though the records do not say whether they were follow-ups.
What Type A and Type B mean
- Type A
- 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
- Violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care.
Both classifications are published by California CDSS and are shown as published. SeniorLivingFacts does not rename them or add a severity level of its own.
At a glance
Counts cover the five-year public record. Typical figures are the median for the 984 Orange County facilities licensed for 6 or fewer beds.
In the available public five-year record, CCLD published 5 reports for this facility: 4 inspections, 1 complaint investigation, and 0 licensing or administrative records.
Those records contain 3 Type A and 4 Type B deficiencies.
3 deficiencies have explicit official correction or clearance evidence in the loaded records.
- Official inspections
- 4
- Recorded deficiencies
- 7
- Type A deficiencies
- 3
- Type B deficiencies
- 4
- Substantiated complaints
- 0
- Repeated topics
- 0
About the same as most this size
1 in the last 12 months
Well above the typical 1
0 in the last 12 months
Most this size have none
0 in the last 12 months
More than the typical 1
0 in the last 12 months
Most this size also have none
0 in the last 12 months
Last 36 months
Repeated topics
Topics cited in more than one report during the last 36 months. A repeat may show a pattern worth asking about. Each date opens its report below.
No topic repeats in the last 36 months
No deficiency topic appears in more than one report during that window. This does not establish that nothing repeated earlier in the five-year record, and it is not a statement about current conditions.
Official report history
All preserved reports from the most recent to the oldest, sortable by report type.
Inspection
No deficiencies recorded in this report
Inspection
Facility condition and maintenanceType A
- Official classification
- Type A
- Official code
- 87303(e)(2)
- Regulation authority
- CCR
What the official deficiency says
(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care. LPA measured the hot water in the two resident bathrooms which measured between 65.6 and 132.2 degrees Farenheit.
Official plan of correction
POC Due Date: 03/07/2025 Plan of Correction LPA observed AD call her plumber during the time of visit and schedule an appointment for later today. AD will send a picture using a thermometer of the hot water once repairs have been completed. POC cleared during visit.
Official record says corrected or clearedRecorded in report dated Mar 6, 2025
Plan of correction recorded
Licensing and administrationType B
- Official classification
- Type B
- Official code
- 1569.618(c)(3)
- Regulation authority
- HSC
What the official deficiency says
(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. During staff file review, LPA observed that 0 out of 4 care giving staff have a valid CPR training card. LPA spoke with AD who stated that none of the staff have a valid CPR training card.
Official plan of correction
POC Due Date: 03/20/2025 Plan of Correction AD agreed to have all four care giving staff complete a valid CPR training. AD will submit proof of the CPR training card to LPA via email or fax by POC date. AD showed LPA proof of 1 out of the 4 care giving staff having a valid CPR training card. POC cleared at time of visit.
Official record says corrected or clearedOn or before Mar 6, 2025
Plan of correction recorded
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87457(c)
- Regulation authority
- CCR
What the official deficiency says
(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. During resident file review, LPA observed the facility does not have a Preappraisal on file for Resident #3 (R3).
Official plan of correction
POC Due Date: 03/20/2025 Plan of Correction AD agreed to complete a Preappraisal for Resident #3 (R3) and submit proof of completion to LPA via email or fax by POC date. AD completed the Preappraisal for R3 dring the visit. POC cleared during time of visit.
Official record says corrected or clearedOn or before Mar 6, 2025
Plan of correction recorded
Admission, assessment, and evictionType B
- Official classification
- Type B
- Official code
- 87463(a)
- Regulation authority
- CCR
What the official deficiency says
(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. During resident file review, LPA observed the facility does not have a Reappraisal on file for Resident #1 (R1), Resident #2 (R2), and Resident #3 (R3).
Official plan of correction
POC Due Date: 03/20/2025 Plan of Correction AD agreed to complete Reappraisals for Resident #1 (R1), Resident #2 (R2), and Resident #3 (R3). AD will submit the Reappraisals to LPA via email or fax by POC date.
Plan of correction recorded
Correction not verified in available records
Staffing, personnel, and trainingType B
- Official classification
- Type B
- Official code
- 87411(c)
- Regulation authority
- CCR
What the official deficiency says
All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 This requirement is not met as evidenced by: Deficient Practice Statement (c) Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. During staff file review, LPA observed that 0 out of the 4 care giving staff completed the required annual training for the year of 2024.
Official plan of correction
POC Due Date: 03/20/2025 Plan of Correction AD agreed to have all the care giving staff to complete the required annual training. AD agreed to submit proof of the training to LPA via email or fax by POC date.
Plan of correction recorded
Correction not verified in available records
Inspection
No deficiencies recorded in this report
Inspection
Dementia careType A
- Official classification
- Type A
- Official code
- 87705(f)(2)
- Regulation authority
- CCR
What the official deficiency says
(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by: - A box storing sharp instruments is observed in a kitchen drawer. The box is missing its lock and cannot be secured. Drawer does not lock either. - Cleaning supplies are observed stored under the kitchen sink. Cabinet is not equipped with a lock or any kind of securing device. - Access door to the garage is left open during daytime, despite the presence of detergent and other cleaning supplies Deficient Practice Statement Based on observation made during today's visit, the licensee did not comply with the section cited above in the three described instances, which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 03/25/2022 Plan of Correction Access to all potentially dangerous items listed above needs to be restricted and secured. Licensee will provide documentation of the corrections being implented to LPA by POE due date.
Plan of correction recorded
Correction not verified in available records
Medication handling and storageType A
- Official classification
- Type A
- Official code
- 87465(h)(2)
- Regulation authority
- CCR
What the official deficiency says
Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: LPAs observed prepoured medication being placed on the dining table with the resident not yet present for the corresponding meal. Cuplet was later placed on a countertop and left there unattened Deficient Practice Statement Based on todays's observations, the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care.
Official plan of correction
POC Due Date: 03/25/2022 Plan of Correction Pre-poured medication will remain centrally stored until the resident is seated and medication is ready to be administred immediately.
Plan of correction recorded
Correction not verified in available records
Source and limits
California Department of Social Services, Community Care Licensing Division. Public facility history is described by the source as a five-year window. Older records and previous-licensee history may require a regional-office request. Type 741 RCFE-CCRCs, nursing homes, and other care settings are excluded from this page.
Read the data methodology