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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606588
Report Date: 04/12/2024
Date Signed: 04/12/2024 03:57:16 PM


Document Has Been Signed on 04/12/2024 03:57 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:TURNING POINT QUALITY CAREFACILITY NUMBER:
197606588
ADMINISTRATOR:WILMA CARSTENSENFACILITY TYPE:
740
ADDRESS:15903 CLEAR SPRING DRIVETELEPHONE:
(562) 943-7900
CITY:LA MIRADASTATE: CAZIP CODE:
90638
CAPACITY:6CENSUS: 4DATE:
04/12/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Michelle Laude - CaregiverTIME COMPLETED:
04:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Erik Zaragoza conducted a subsequent unannounced Required 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools to complete the annual inspection that was begun on. LPA explained the purpose of the visit to Wilma Carstenson, administrator for the facility, and was admitted entrance. There are four (4) residents currently living in the facility.

The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Rights/Information, Resident Records/Incident Reports, Food Service, Planned Activities, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs.

Infection Control:

· Infection control practices and Personal Protective Equipment (PPEs) were observed. Infection Control Plan will be submitted to LPA within seven (7) days.


Physical Plant/Environment Safety:

· The facility is a single-story home located in a residential neighborhood. It is licensed for a capacity of six (6) residents, all of which may be non-ambulatory, four (4) may be receiving hospice. It has four (4) resident bedrooms, a dining room, a living room, a kitchen which contains the washer and dryer machines for the facility, two (2) residents bathrooms of which Restroom #1 had a hot water temperature reading at 109.7 Degrees F and Restroom #2 had a hot water temperature reading of 107.2 Degrees F, a backyard patio which contained a shaded area for residents, and also a detached garage that functions as the facility’s storage and holds additional food and incontinence supplies. Cleaning supplies and chemicals are kept locked in the kitchen of the facility.

SUPERVISOR'S NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik ZaragozaTELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2024
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 4


Document Has Been Signed on 04/12/2024 03:57 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754


FACILITY NAME: TURNING POINT QUALITY CARE
FACILITY NUMBER: 197606588

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.625(b)(2)
Other Provisions
(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 4 out of 4 staff members, as there was no documentation of their annual retraining on Dementia Care, hospice care, restricted health conditions, and postural supports, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/03/2024
Plan of Correction
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Administrator is to ensure that dates on which annual retraining is conducted on required topics is documented. Administrator is to email LPA a plan of how they will ensure that staff retraining will be documented properly moving forward.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik ZaragozaTELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2024
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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: TURNING POINT QUALITY CARE
FACILITY NUMBER: 197606588
VISIT DATE: 04/12/2024
NARRATIVE
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·The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. The facility has two (2) fully charged fire extinguisher located on both floors of the facility, including the basement. There were no sharp objects that were left accessible to residents.
· Water temperature readings measured between the required 105 - 120 degrees Fahrenheit.
Operational Requirements:
· Fire clearance was approved by LA County Fire Department for a capacity of six (6) residents, all of which may be non-ambulatory, four (4) may be receiving hospice.
· Care and supervision to meet the clients’ needs was observed.
· The Program Design was reviewed.

Resident Rights/Information:

· Physician orders were reviewed for four (4) resident files.

· Medications were also reviewed for four (4) residents.

Resident Records/Incident Reports:

· Four (4) resident files were reviewed containing admission agreements, Physician's Report, medical/functional assessments, Needs and Services Plans, TB clearance, Appraisal/Needs and Services Plan, personal rights, medical consent, and medication records were reviewed.


Food Service:

· The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary.

SUPERVISOR'S NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik ZaragozaTELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: TURNING POINT QUALITY CARE
FACILITY NUMBER: 197606588
VISIT DATE: 04/12/2024
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Personnel Records/Staff Training:

· Four (4) staff files were reviewed for criminal background clearance and training.


· Personnel records have health/TB screenings, CPI training, certifications, and 1st Aid/CPR training.
  • Required annual retraining on Dementia care, Hospice care, Postural Supports, and Restricted Health Conditions were not documented.
Incident Medical and Dental:

· All residents have an Appraisal/Needs and Services Plan on file.

Disaster Preparedness:

· Emergency and Disaster Plan was publicly posted and found within the facility.

· An emergency and disaster drill was last conducted on 4/2/2024.

Staffing:

· A total of four (4) full-time staff members provide care and supervision to the clients.

Personnel Records/Staff Training:

· Five (5) staff files were reviewed for criminal background clearance and training.


· Personnel records have health/TB screenings, CPI training, certifications, and 1st Aid/CPR training.

Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiency observed during the visit are documented on the LIC809D. Exit interview held and a copy of the report along with appeal rights were provided.
SUPERVISOR'S NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik ZaragozaTELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4