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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 134602495
Report Date: 10/26/2023
Date Signed: 10/26/2023 12:22:46 PM


Document Has Been Signed on 10/26/2023 12:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:CASA ELITEFACILITY NUMBER:
134602495
ADMINISTRATOR:IRMA PINEDAFACILITY TYPE:
740
ADDRESS:1785 CITRUS LANETELEPHONE:
(760) 352-9591
CITY:EL CENTROSTATE: CAZIP CODE:
92243
CAPACITY:8CENSUS: 6DATE:
10/26/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Caregiver Veronica NaranjoTIME COMPLETED:
12:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Case Management visit to cite deficiencies discovered during a complaint investigation. The LPA introduced himself and disclosed the purpose of the visit to Caregiver Veronica Naranjo.

Interviews, along with observations by the LPA, revealed the facility had used cannabis oil, and dried cannabis leaves to make teas for residents in care. The Cannabis oil was stored in the kitchen area in an unlocked location. Additionally, the Cannabis oil did not have the required labels. Prescribed Cannabis Gummies were also witnessed to be stored in the kitchen area in an unlocked location.

These deficiencies were cited in an LIC 809D, and a Plan of Correction was jointly formulated with Administrator Pineda, over a telephone call.

An exit interview was conducted with Naranjo, to whom a copy of this report, LIC 809D, and Licensee/Appeal Rights (LIC 9058), were provided
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2023
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 2


Document Has Been Signed on 10/26/2023 12:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108


FACILITY NAME: CASA ELITE
FACILITY NUMBER: 134602495

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/26/2023
Section Cited
CCR
87465(h)(2)

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87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) 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 was not mer as evidenced by:
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Administrator agreed to provide centrally store medication training to all staff and submit proof of training, by 11/17/23.
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Based on interviews and observation, the Licensee did not ensure centrally stored medication was locked in a place no accesible to residents in care, which posed a potential health, safety, and personal rights risk to 6 of 6 residents in care.
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Type B
10/26/2023
Section Cited
CCR87475(h)(4)

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87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. This requirement was not met as evidenced by:
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Administrator agreed to provide centrally store medication training to all staff and submit proof of training, by 11/17/23.
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Based on interviews and observations, the Licensee did not ensure centrally stored medication was labeled and maintained in complaince, which posed a potential health, safety, and personal rights risk to 6 of 6 residents 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.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2023
LIC809 (FAS) - (06/04)
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