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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606773
Report Date: 11/29/2022
Date Signed: 11/29/2022 12:48:07 PM


Document Has Been Signed on 11/29/2022 12:48 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:BEST ELDER CARE IIIFACILITY NUMBER:
197606773
ADMINISTRATOR:FABIOLA IGIDFACILITY TYPE:
740
ADDRESS:38648 CORTINA WAYTELEPHONE:
(661) 274-2413
CITY:PALMDALESTATE: CAZIP CODE:
93550
CAPACITY:6CENSUS: 6DATE:
11/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:18 AM
MET WITH:Vincent IgidTIME COMPLETED:
01:00 PM
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On 11/29/2022 at 11:18 a.m. Licensing Program Analyst (LPA) Evelin Rios arrived at the facility mentioned above to conduct a Required Annual/Infection Control inspection. LPA was greeted by Staff Vincent Igid who was wearing a mask and granted access. LPA asked Vincent to call administrator Fabiola Igid. Fabiola will not be able meet us at the facility because she is with a resident at their doctor's appointment. LPA explained the reason for the visit over the phone to Fabiola. Fabiola designated Vincent to sign for this report. LPA reviewed the Mitigation Plan approved 03/06/2021. The inspection tool was used to complete the visit.

At 11:21 a.m. LPA began a physical plant tour of the facility and following was observed:

Dining / Living Area: The dining and living area were well lit, clean and clear of clutter. Furniture appeared clean and in good repair. LPA observed proper Covid-19 signs posted through out the facility. LPA observed the thermostat at a comfortable temperature of 75°F

Tv Area: In the TV area LPA observed it to be clean and clear of clutter. Furniture appeared clean and in good repair. A fireplace located in the TV area is not in use.

Kitchen: LPA observed the kitchen to be clean and clear of clutter. All appliances were functioning. LPA observed two (2) day perishable and seven (7) day non-perishable foods. Cleaning solutions are locked under the sink. The fire extinguisher one (1) of two (2) was observed in the kitchen and was last serviced on 07/15/2022. Fire extinguisher two (2) of two (2) was observed in the hallway with service date 07/15/2022.

Bedrooms: There are five (5) bedrooms designated for resident use. Five (5) out five (5) resident rooms are furnished with required lighting, dresser, chair, bed, and linens. There was an extra supply of linens in a hallway closet. One (1) of five (5) bedrooms is shared by a couple.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin RiosTELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022
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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: BEST ELDER CARE III
FACILITY NUMBER: 197606773
VISIT DATE: 11/29/2022
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Bathrooms: There are three (3) bathrooms designated for resident use. One (1) bathroom is located in the shared bedroom and the other two (2) bathroom are designated and accessible for all residents. All bathrooms were well lit, clean, had grab bars, nonskid mats and trash bins with lids. LPA observed hand washing signs, sufficient supply of hand soup and paper towels. At 11:46 a.m. water temperature in one (1) of three (3) bathroom was measured at 105.1 degrees Fahrenheit.

Laundry Closet: Washer and dryer appeared to be in good repair and laundry detergent is kept locked in a cabinet above the dryer.

Surrounding Grounds: There were no visible hazards, and passageways were free from obstruction. Side gate of the house was closed but unlocked. There is a covered patio to provide shade and appropriate outdoor seating for residents.

Medications/ Resident file: LPA observed, resident medications in a locked cabinet in the dining/living area and resident files locked in a file cabinet in the TV area inaccessible to residents.

LPA observed smoked alarms through out the facility. Smoke alarms are hard wired and interconnected. At 11:46 a.m. smoke alarms were tested and functioning properly. Two (2) carbon monoxide detectors were observed and appeared to be functioning. Vincent states the facility has enough PPE for 30 days.



No deficiencies were observed during todays visit and the facility is currently following their infection control plan.

Exit interview conducted and a copy of this report issued.
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin RiosTELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022
LIC809 (FAS) - (06/04)
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