Skip to main content

Inspection visit

Routine inspection

LAKE FOREST COUNTRY HOME IIILicense 3060012611 citation on this visit
1 citation recorded

Inspector’s narrative

What the inspector wrote

On this date January 30, 2025 Licensing Program Analyst (LPA) William Vanegas made an unannounced visit to conduct the required annual inspection. LPA was greeted and granted entry by facility staff after explaining the purpose for the visit. Licensee Carmen Rivas was present to assist with the inspection.LPA observed that Administrator Diane Antonini has a valid Administrator certificate which expires on May 29, 2026. LPA began a tour of the facility and observed the following. The facility is a single-story home with five resident bedrooms, one staff room, two shared resident bathrooms, a living room, a dining room, a kitchen, and an unattached two car garage. LPA observed four residents in care, none of which are on hospice, and two caregivers present. LPA observed residents in the living room and their bedrooms. LPA observed the See Something, Say Something poster (PUB 475) mounted on a wall by the entryway of the facility. LPA inspected the five resident bedrooms, and they were observed to be free of any hazards. LPA observed the resident bedrooms had the required furnishings of a bed, a chair, a chest of drawers, reading lamp, and enough storage space to store personal belongings. All resident beds had clean linens in good repair; meaning no strains or tears. LPA observed additional linens are stored in a hallway closet. LPA inspected the two shared resident bathrooms. Resident bathrooms are clean. Bathrooms are equipped with grab bars, slip resistant floor mats, and shower chairs. Faucets and toilets were operational. Hot water temperature measured between 115.8 and 117.4 degrees Fahrenheit. LPA observed kitchen area to be clean, and free of any mildew and debris. LPA observed the facility to have a two-day perishable and seven-day nonperishable food supply on hand. LPA observed kitchen appliances to be clean and operational. LPA observed kitchen knives are stored in a locked kitchen cabinet. LPA observed cleaning supplies are stored in a locked kitchen cabinet under the sink. CONTINUED ON LIC809-C LPA observed all smoke detectors and carbon monoxide detectors to be in good repair and operational. LPA observed all fire extinguishers to be fully charged, and up to date. LPA Vanegas observed first aid kit to have all required items such as adhesive tape, scissors, bandages, tweezers, a thermometer, and a first aid manual. LPA conducted a tour of the outside of the facility and observed the following. There is an outdoor shaded seating area, no hazards or objects were observed along the sides of the exit routes. Side doors were unlocked and self latching. LPA Vanegas reviewed four resident files, and two staff files all resident files had all required documents, however two staff files that were reviewed did not have the required training a deficiency was issued on today's date. LPA reviewed medication administration log and medications with licensee, per LPA review no discrepancies were found, and medications are being administered per physicians orders. Based on observations made during today's inspection deficiencies will be issued. An exit interview was conducted with Licensee Carmen Rivas, and a copy of this report was provided to the facility.

Citations

1 citation recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 1569.69(a)(2)Type B

    Based on record review, the licensee did not comply with the section cited above in two out of two staff on duty did not have the required training completed and documented, which poses safety risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the January 30, 2026 inspection of LAKE FOREST COUNTRY HOME III?

This was a inspection inspection of LAKE FOREST COUNTRY HOME III on January 30, 2026. 1 citation were issued: 1 Type B.

Were any citations issued to LAKE FOREST COUNTRY HOME III on January 30, 2026?

Yes, 1 citation was issued (0 Type A, 1 Type B). The first citation was for: "Based on record review, the licensee did not comply with the section cited above in two out of two staff on duty did not..."

What type of inspection was this?

This was a inspection inspection. inspection inspections are conducted by CCLD as part of their licensing oversight.

SourceView on CCLDView original report

Share this reportEmail

Next steps

If this is your facility,claim this pageand correct anything the record gets wrong. Free.

Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.

Data from CCLD public records. Last updated . If you believe any information is inaccurate, report it here.