197603946-5-12-2021-31-AS-MSPH-C2XVJ6-20210512162812

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197603946
Report Date: 05/12/2021
Date Signed: 05/12/2021 04:29:17 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:	STRAWBERRY FIELDS		FACILITY NUMBER:	197603946
ADMINISTRATOR:	DAVID JAMES TAYLOR		FACILITY TYPE:	740
ADDRESS:	434 E LANCASTER BLVD		TELEPHONE:	(661) 206-7925
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY:	6	CENSUS: 5	DATE:	05/12/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:07 PM
MET WITH:	David Taylor		TIME COMPLETED:	03:35 PM

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LPA Spaeth conducted an infection control visit with Administrator David Taylor. Upon arriving at the front door at 2:07 pm, LPA observed the appropriate COVID-19 signs on the front door. LPA Spaeth was greeted by caregiver, Zoila Dubon. LPA Spaeth confirmed staff member has previously cleared background check. Caregiver then called Administrator, David Taylor. Administrator arrived at 2:20 pm.

LPA Spaeth confirmed there are five residents at the facility. When LPA entered the facility, LPA observed Administrator and staff member were wearing a mask. LPA’s temperature was taken, recorded in the visitor log, and LPA Spaeth signed the visitor log. LPA Spaeth observed a resident in the living area watching television but not wearing a mask. Administrator stated that resident refuses to wear a mask.

Administrator began the tour by showing the backyard. LPA Spaeth observed comfortable chairs available for residents and guests. The Administrator stated when family members come to visit residents, the resident and family member visit outside.

Upon entering the facility, LPA Spaeth was shown the office location of the facility. LPA Spaeth observed a twin bed available for staff use. There are no live in staff at the facility but Administrator stated if a resident is positive for COVID, the resident would be moved to this room. LPA was then escorted to a male resident’s room. LPA observed the resident was bedridden but spoke to LPA. LPA Spaeth explained the purpose of visit to resident.

Across the hall, LPA observed the first bathroom which contained wash your hands sign, trash can, liquid soap, and no paper towels. Administrator stated residents had been flushing the paper towels in the toilet and the Administrator has had to call a plumber several times. Administrator stated residents use own hand towels and staff members make sure the hand towels are provided for residents.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2021

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: STRAWBERRY FIELDS	FACILITY NUMBER: 197603946
	VISIT DATE: 05/12/2021

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Within the hallway was a locked cabinet which contained PPE, laundry detergent, and cleaning supplies. LPA observed an adequate supply of gloves, surgical masks, N95 masks, gowns, and hand sanitizer. Administrator stated has a 90 day supply of PPE which some of the supplies are stored at the other Facility, Strawberry Cottage.

Upon entering the kitchen, LPA Spaeth observed locked medications within a kitchen cabinet, locked knives, wash your hands sign, paper towels, and hand soap. LPA Spaeth observed a sufficient supply of fresh fruits and vegetables, milk, and eggs within the refrigerator. The freezer contained an ample supply of meats. There are two pantry locations within the kitchen and LPA observed a supply of canned goods.

LPA was then led to the living room to the other side of the house where three resident rooms and another bathroom are located. The first resident room is vacant. The second resident room is for two female residents. LPA observed all the necessary furniture within the room and the beds were six feet apart. The next room is a room for two male residents. LPA observed the required furniture and observed the beds were six feet apart. LPA observed the second bathroom contained hand soap, hand towels, a trash can and wash your hands sign.

LPA Spaeth confirmed with Administrator all staff have received proper infection control training such as donning and doffing procedures, sanitizing requirements when cleaning the facility, and other needed COVID-19 trainings. Administrator confirmed all staff are aware of the sick/leave policies for the facility. Administrator also confirmed that the high traffic areas are sanitized two times per day. Administrator also confirmed in case of a staff shortage due to COVID, the Administrator has an agency available if needed.

LPA Spaeth concluded visit at 3:05 pm. Exit interview conducted and a copy of the report was emailed to Administrator instructing Administrator to sign report and forward to LPA Spaeth via email.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2021

LIC809 (FAS) - (06/04)

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