197603524-9-29-2023-31-AS-LCAS-CW5UWY-20230929155732

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197603524
Report Date: 09/29/2023
Date Signed: 09/29/2023 03:59:04 PM

Document Has Been Signed on 09/29/2023 03:59 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	DURANDO HOME, INC.		FACILITY NUMBER:	197603524
ADMINISTRATOR:	JAMES DURANDO		FACILITY TYPE:	740
ADDRESS:	1208 WEST H-15		TELEPHONE:	(661) 940-5418
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY:	4	CENSUS: 4	DATE:	09/29/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	James Durando		TIME COMPLETED:	04:00 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) Lorena Casillas and Evelin Rios conducted an unannounced visit and were greeted by staff #1 (S1). LPA stated the purpose of the visit was to conduct an annual inspection. Staff confirmed there are four residents living at the facility. The facility is licensed for four residents of which four are ambulatory. Staff called the Administrator and the Administrator arrived at 10:15 am. LPAs toured the facility at 8:45am until 10:00 am Common Areas – LPAs observed the living room contained seating. The dining room contained dining room table and chairs. Kitchen – LPAs observed the knives were locked in a kitchen cabinet. The medications and first aid kit were locked in a kitchen cabinet. LPAs observed a two-day supply of perishable foods and a seven day supply of non-perishable foods. Resident Bedrooms - There are four resident bedrooms which are furnished with a bed, linens, nightstand, chest of drawers and a closet. Bathroom - There are two bathrooms located in the facility. LPA Rios tested the water temperature in two of two bathrooms at 11:05am in which temperatures were between 105 degrees F and 120.0 degrees F. Both bathrooms contained hand soap, paper towels, trash can, and grab bars. One out of two bathrooms did not contain slip resistant mat in the shower. S1 states that resident that uses that shower does not like shower mats and removes them. Administrator purchased a shower mat during visit. (LIC809C Continued on next page)

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena Casillas	TELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: DURANDO HOME, INC.	FACILITY NUMBER: 197603524
	VISIT DATE: 09/29/2023

NARRATIVE

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(Continued from LIC809)

Smoke/Carbon Monoxide Detectors – The detectors were tested at 11:04 am and were observed to be operable.

Yard -LPAs observed that yard area was clean and free of clutter.

At approximately 10:30am LPAs reviewed resident’s records. LPAs review of the medication administration record revealed that for Resident #2 (R2) their medication log and count for September 8, 2023, did not match. Administrator called staff #2 who explained that they did not recall what occurred on said date. Administrator then received a call from staff #3 (S3) and they explained that on said date they received a call from the pharmacy indicating that medication was to be suspended until lab results for R2 were received. LPAs interview with S3 revealed that S2 mistakenly logged in administering medication.

At approximately 10:50am LPAs reviewed staff records. LPAs observed three of three staff records did not have the yearly required annual training. Administrator stated that they believed that the initial forty hours were sufficient. Two out of the three staff files reviewed were missing CPR and First Aid certifications. Two out of the three staff files reviewed were missing employee rights.

Administrator was asked to produce liability insurance certificate but was not able to do so. Administrator states that they have it but will have to look for it.

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

Exit interview conducted, Appeal Rights discussed, and a copy of the signed report was provided.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena Casillas	TELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/29/2023 03:59 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: DURANDO HOME, INC.	FACILITY NUMBER: 197603524
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/29/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87219(a)(1)

Planned Activities

(a) Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities. The activities made available shall include: (1) Socialization, achieved through activities such as group discussion and conversation, recreation, arts, crafts, music, and care of pets. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPAs observation and staff interview, the licensee did not comply with the section cited above in one out of four residents not having any activities calendar on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/13/2023
	Plan of Correction
1 2 3 4	Administrator will provide a copy of activity calendar by POC due date via email or text.

Type B

Section Cited

CCR

87411(c)

(c) 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
1 2 3 4	Based on record reviewand staff interview, the licensee did not comply with the section cited above in three out of three staff records that were missing annual trainings and two of three staff records were missing CPR and First Aid certifications which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/20/2023
	Plan of Correction
1 2 3 4	Administrator will have all staff complete all required training mentioned in HSC 1569.625 and 1569.69. Administrator will send name of training and hours completed to LPA via email by POC due date.

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: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena Casillas	TELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023

LIC809 (FAS) - (06/04)

Page: 3 of 7

Document Has Been Signed on 09/29/2023 03:59 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: DURANDO HOME, INC.	FACILITY NUMBER: 197603524
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/29/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1796.37(a)(2)

(a) THe department may issue a home care organization license to a home care organization applicant that satisfies the requirements...(2) Submits proof of general and prefessional liability insurance in the amount of at least one million dollars ($1,000,000) per occurance and three million dollars ($3,000,000) in the aggregate. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above due to not having a liability insurance when they are responsible for safeguarding cash resources which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/13/2023
	Plan of Correction
1 2 3 4	Admiistrator will provide LPA a copy of the certificate of liability insurance via email by 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.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena Casillas	TELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023

LIC809 (FAS) - (06/04)

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