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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606257
Report Date: 07/01/2022
Date Signed: 07/01/2022 11:19:35 AM

Document Has Been Signed on 07/01/2022 11:19 AM - 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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:EASTER SEALS SOUTHERN CALIFORNIA PASO ROBLES HOUSEFACILITY NUMBER:
197606257
ADMINISTRATOR:VEGA TAPIA, DANNYFACILITY TYPE:
735
ADDRESS:7306 PASO ROBLES AVETELEPHONE:
(818) 609-8227
CITY:VAN NUYSSTATE: CAZIP CODE:
91406
CAPACITY: 3CENSUS: 2DATE:
07/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jose M TurciosTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Brian Balisi arrived to this facility today to conduct a One (1) year Required inspection of this facility with emphasis on infection control practices and procedures. LPA met with DSP Jose M Turcios and explained the reason for the visit. Administrator Danny Tapia informed LPA that Jose can sign report in his absence.

A tour of the physical plant was conducted with Jose approximately between 9:00am - 11:30am  LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. The following was noted: Facility is a single story residence consists of three (3) resident bedrooms and three (3) bathrooms.  LPA observed fully charged fire extinguishers last serviced in February 2022. All smoke alarms and carbon monoxide detector were tested and functioned properly during time of visit. Emergency drill was last conducted in June 2022. LPA observed required postings throughout the facility.

Kitchen:  The kitchen appeared clean and the appliances and fixtures functional during the time of visit.  LPA observed a sufficient amount of perishable and non-perishable food at the facility; Sharp objects are stored in a locked cabinet  to the left of the washer and dryer. Medications, first aid and cleaning supplies were observed stored in this locked cabinet as well. Cabinets above the washer and dryer were observed to store non-perishable food and snacks.

Bedrooms:  The resident bedrooms were properly furnished with at least one chair, night stand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. At approximately 10:30am, LPA observed residents listening to music and participating in zoom programs.

Continued on 809-C
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE: DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2022
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. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: EASTER SEALS SOUTHERN CALIFORNIA PASO ROBLES HOUSE
FACILITY NUMBER: 197606257
VISIT DATE: 07/01/2022
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Continued from 809

Bathrooms:  LPA observed all bathrooms were clean, properly supplied and had functional fixtures. LPA observed grab bars and non-skid mats in all bathrooms. Residents have sufficient amounts of supplies for personal hygiene. The hot water was measured in each bathroom during physical plant tour. Hot water measured within the required limit of 105-120 degrees Fahrenheit in all bathrooms during visit.

Common Areas:  These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. LPA observed board games and other activities stored beneath a side table next to the couch.

Surrounding Grounds (Outdoors): There was a shaded area with proper furniture for outdoor use. There are no bodies of water on the premises. Entry/exits were free of obstruction during the time of the visit. There is a detached garage located on the premises. LPA observed garage to store extra PPE supplies, medical supplies, extra furniture and cleaning supplies.

The LPA spoke with Jose regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate each bedroom as a single isolation room if the facility has a confirmed case of COVID-19. COVID-19 testing is conducted weekly if anyone shows any symptoms or exposures. The facility’s policies and procedures as it pertains to infection control are adequate at this time.

Exit interview conducted, report issued and sent via email.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:

DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2022
LIC809 (FAS) - (06/04)
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