197600297-12-29-2024-31-AS-ADUA-DCERZX-20241229122841

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197600297
Report Date: 12/29/2024
Date Signed: 12/29/2024 12:28:56 PM

Document Has Been Signed on 12/29/2024 12:28 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	TRUDEZ HOME CARE		FACILITY NUMBER:	197600297
ADMINISTRATOR/ DIRECTOR:	LOPEZ, VIRGILIO		FACILITY TYPE:	740
ADDRESS:	25821 OLIVAS PARK ROAD		TELEPHONE:	(661) 259-1827
CITY:	VALENCIA	STATE: CA	ZIP CODE:	91355
CAPACITY: 5	TOTAL ENROLLED CHILDREN: 0	CENSUS: 4	DATE:	12/29/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:18 AM
MET WITH:	Eileen Calderon		TIME VISIT/ INSPECTION COMPLETED:	12:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Abeye Duguma met with Eileen Calderon for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at around 9:45 AM and the following was noted: There is one entrance being utilized at the facility. The facility has a total of four (04) bedrooms of which three (03) are for residents and two (02) bathrooms. The facility is fire cleared for five (05) non-ambulatory. The facility is currently occupying four (04) residents. The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. The garage is currently being used for storage. Laundry detergents, cleaning agents and other toxins are locked away. Kitchen is sufficiently stocked with at least two (02) days perishable and seven (07) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents. The living and dining room are neat and clean. The facility maintains a comfortable temperature at 74°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher is located near the kitchen and observed to be fully charged and last inspected 04/29/2024. (continued on LIC 809-C)

Naira Margaryan	TELEPHONE: (818) 596-4368
Abeye Duguma	TELEPHONE: (818) 669-6814
	DATE: 12/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: TRUDEZ HOME CARE	FACILITY NUMBER: 197600297
	VISIT DATE: 12/29/2024

NARRATIVE

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The residents' rooms are furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 112.3°F. Towels and washcloths are not shared. There was enough clean linen available in the cabinets.

LPA observed medication to be locked and inaccessible to residents. Facility maintains a complete first aid kit.

During the physical plant tour, LPA observed three beds with full or half railing. Of the two beds in room #4, one was full and the other half railing. The bed in room #3 is half railing only. LPA requested a written order from a physician indicating the need for the postural support, however, staff was unable to furnish such documents.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D):

No other health and safety hazards noted during the visit.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/29/2024 12:28 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: TRUDEZ HOME CARE	FACILITY NUMBER: 197600297
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

87608 Postural Support (a)(3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by: During the physical plant tour, LPA observed three beds with full or half railing. Of the two beds in room #3, one was full and the other half railing. The bed in room #2 is half railing only. LPA requested a written order from a physician indicating the need for the postural support, however, staff was unable to furnish such documents.
	Deficient Practice Statement
1 2 3 4	Based on observations, 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.
	POC Due Date: 01/05/2025
	Plan of Correction
1 2 3 4	The Licensee/Administrator will either procure a written order from a physician indicating the need for the postural supports for all identified beds or replace all beds by the POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Naira Margaryan	TELEPHONE: (818) 596-4368
Abeye Duguma	TELEPHONE: (818) 669-6814
	DATE: 12/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2024

LIC809 (FAS) - (06/04)

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