157209235-9-14-2023-24-AS-AWAN-CVNPZZ-20230914114623

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 157209235
Report Date: 09/14/2023
Date Signed: 09/14/2023 11:46:33 AM

Document Has Been Signed on 09/14/2023 11:46 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME:	TLC HOME CARE 2		FACILITY NUMBER:	157209235
ADMINISTRATOR:	ARRIETA JR, RODRIGO A.		FACILITY TYPE:	740
ADDRESS:	207 RIESLING VINES ST		TELEPHONE:	(661) 203-7565
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93314
CAPACITY:	6	CENSUS: 5	DATE:	09/14/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Facility Staff, Eufemmia Caridad and Facility Staff, Marie Kriz Yu		TIME COMPLETED:	11:59 AM

NARRATIVE

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On 09/14/2023, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Facility staff contacted Administrator, Rodrigo Arrieta via telephone. LPA spoke with Administrator via telephone and was informed that the Administrator has a prior obligation and is unable to attend this inspection. LPA received verbal permission to conduct a facility tour with facility staff E. Cardidad and M. Yu.

LPA conducted a tour inside and outside of facility. Facility observed to be clean, odor free and at a comfortable temperature. Common areas were furnished well with adequate seating and lighting available. Resident rooms appeared clean and had required furnishings. LPA observed an adequate supply of linen. Resident bathrooms were properly equipped with securely fastened grab bars in toilet and tub/shower areas, non-skid mats were observed. Hot water measure at 115.3 degrees F in the shared bathroom and 113.7 degrees F in bathroom 1. Kitchen toured, appeared clean, observed an adequate food supply. LPA observed cleaning supplies and disinfectant to be accessible to residents in care. Exterior tour conducted, all exits open and free of obstructions. Side gate was observed to be self-latching.

Fire extinguisher serviced on 07/08/2022. LPA will return on a later date to review resident and staff files, and medications.

Deficiencies are bing cited in accordance to California Code of Regulations, Title 22, Division 6 on the attached 809D.

Exit interview conducted and a plan of correction was reviewed and developed. A copy of this report and appeal rights were discussed and provided to facility staff, Eufemmia Cardidad, whose signature on this form confirms receipt of this document.

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Alexandria Walton	TELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/14/2023 11:46 AM - 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: TLC HOME CARE 2	FACILITY NUMBER: 157209235
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/14/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87309(a)

Storage Space

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above when disinfectants and cleaning solutions were observed to be accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 09/15/2023
	Plan of Correction
1 2 3 4	Licensee agrees to store all cleaning solutions and disinfectants where they are inaccessible to residents in care by the POC due date. Licensee will submit a written statement detailing the steps the facility will take to ensure all items which could pose a danger if readily available to clients are stored where inaccessible to residents in care to the Fresno CCL office by the POC due date.

Type A

Section Cited

CCR

87203

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above when the fire extinguisher was observed to be last serviced on 07/08/2023, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 09/15/2023
	Plan of Correction
1 2 3 4	Licensee agrees to purchase a new fire extinguisher or have the current fire extinguisher serviced and submit proof of purchase or service by the POC due date to the Fresno CCL office.

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: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Alexandria Walton	TELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

LIC809 (FAS) - (06/04)

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