197603599-9-23-2022-31-AS-RRAZ-CKSTRU-20221102145803

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603599
Report Date: 09/23/2022
Date Signed: 09/23/2022 11:49:40 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

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

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/19/2022 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20220919192635

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: 5	DATE:	09/23/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Jubilee Egid, Staff member		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

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Facility staff did not adhere to COVID-19 protocols.

INVESTIGATION FINDINGS:

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At 10:00am Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced complaint visit to investigate the allegations above. LPA was greeted by Staff #1 (S1), Jubilee Egid, who granted access to the facility. LPA explained the reason for the visit.

Upon arrival LPA was screened for an infection control, and observed Staff #2 (S2) was not wearing a mask. LPA, then, asked S2 to wear their mask.

During today’s visit, S1 contacted the Administrator and LPA was informed that the Administrator was not able to come to the facility and designated S1 to sign for the report.

LPA conducted a physical plant tour of the facility, from approximately 10:10am-10:40am, to ensure no immediate health and safety issues were present.
Continue on LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022

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

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20220919192635

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 09/23/2022

NARRATIVE

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Interviews with the Administrator and S1 confirmed that sometime, around July 2022, a random visit was made by a credible witness who observed facility staff were not wearing masks. Administrator admitted that a verbal conversation with the credible witness took place on 08/18/22 and a staff meeting regarding COVID protocols was held on 08/19/22. Based on an interview conducted with the Administrator and LPA observation this allegation is substantiated at this time.

Deficiencies were issued per CA code of Regulations Title 22 on LIC9099-D with this report. Appeal rights issued. Report signed and delivered. Exit interview conducted.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20220919192635

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/23/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/24/2022 Section Cited CCR 87470(c)(1)(F)	1 2 3 4 5 6 7	87470(c) Infection Control Requirements shall be developed by the licensee... (1) The Infection Control Plan shall include: (F) Staff shall demonstrate knowledge... appropriate to the job assigned and... This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee/Administrator agreed to provide in house training with all staff regarding Infection Control Requirements and COVID Protocol. A written statement signed by all staff regarding such training shall be emailed to LPA no later than 09/24/22.
	8 9 10 11 12 13 14	Based on an interview with the Administrator, the licensee/administrator stated that during a previous visit conducted by the credible witness, staff did not comply with the section cited above by not wearing masks, which poses and immediate Health and Safety and personal rights risk to persons in care.	8 9 10 11 12 13 14
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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: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022

LIC9099 (FAS) - (06/04)

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