197603599-10-21-2021-31-AS-APAA-C7ZR6F-20211021124439

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197603599
Report Date: 10/21/2021
Date Signed: 10/21/2021 12:45:17 PM

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:	BEST ELDER CARE		FACILITY NUMBER:	197603599
ADMINISTRATOR:	IGID, FABIOLA		FACILITY TYPE:	740
ADDRESS:	37620 SIMI STREET		TELEPHONE:	(661) 878-8105
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93552
CAPACITY:	6	CENSUS: 6	DATE:	10/21/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Fabiola Igid, Administrator		TIME COMPLETED:	01:05 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

At 11:25am Licensing Program Analysts (LPAs), Angela Panushkina and Shira Stamps conducted an unannounced annual inspection at the facility mentioned above. LPAs were greeted by staff, Jubilee Egid, who granted access to the facility. At approximately, 11:40am Administrator, Fabiola Igid, arrived and physical tour was conducted. LPAs observed the following:

Infection control: LPA reviewed the facility mitigation plan (approved on 03/06/2021) to make sure licensee was following current infection control recommendations. Upon arrival, LPA team was screened and asked to sign-in the visitors’ log. In addition, LPAs were asked all infection control questions. Proper signage was observed inside along the hallway and in the restrooms. Hand sanitizer was also observed. Administrator stated they have sufficient PPE supplies for residents and staff.

Kitchen: At approximately, 11:25am LPAs toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. Appliances in the kitchen appeared to be functional. All knives and sharp objects were locked and inaccessible to residents in care.

Smoke detectors/carbon monoxide. Dual smoke and carbon monoxide detectors were located throughout the facility, and at 11:56am they were tested and observed to be operational.

Bedrooms: There are four (4) out of five (5) bedrooms designated for residents' use and have sufficient lighting. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Auditory alarms are in a good repair, were tested and observed to be operational.

Bathrooms: At 11:45am LPAs observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. The hot water temperature measured at 111.9°F, at approximately, 11:52am. LPAs observed appropriate grab bars and non-skid mats as well as hand washing signs posted in each bathroom. All trash cans had fitted lids.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021

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

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: BEST ELDER CARE	FACILITY NUMBER: 197603599
	VISIT DATE: 10/21/2021

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
26
27
28
29
30
31
32

Common Areas: The facility maintains a comfortable temperature at 72°F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. Laundry area was kept clean and all detergents kept locked. There are fire extinguishers, in the kitchen area and the hallway and were last serviced on 06/02/21.

Outside areas: At approximately 11:58am, LPAs toured the outside area of the facility. LPAs observed appropriate outdoor furniture, with a covered shaded area for clients. LPAs discussed the importance of maintaining the care and supervision to meet the needs of residents There are no bodies of water.

The garage: Facility has an attached garage that is used for extra PPE supplies and food storage. LPAs observed garage being locked and inaccessible to residents.

Medications: At approximately, 11:43am LPAs observed medications are centrally stored and locked in the hallway cabinet and inaccessible to residents in care.

Administrative: LPA collected Certificate of Liability Insurance, and LIC.500. Annual fees are current .

Exit interview conducted and copy of this report was provided to the Administrator.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 10/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2