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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197606875
Report Date: 01/26/2022
Date Signed: 01/26/2022 11:55:49 AM

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:A PLUS ELDERLY CAREFACILITY NUMBER:
197606875
ADMINISTRATOR:MARITA AMORSOLOFACILITY TYPE:
740
ADDRESS:43835 JOHNS COURTTELEPHONE:
(661) 723-0212
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:6CENSUS: 5DATE:
01/26/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Marita SanmaniegoTIME COMPLETED:
12:10 PM
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At 10:05 a.m. Licensing Program Analyst (LPA) Melissa Ruiz conducted an unannounced annual inspection at the facility mentioned above. LPA was greeted by staff who granted access to the home. This is a 6-bedroom, 3-bathroom single story facility. LPA later met with Administrator Marita Sanmaniego, entrance interview was conducted and at 10:20 a.m. a physical tour was initiated.

Infection control:
LPA reviewed the facility mitigation plan (approved on 02/6/2021) to make sure licensee was following current infection control recommendations. Upon arrival, staff took LPA’s temperature, was asked to sign-in the visitor’s log and was asked infection control questions. Proper signage was observed posted outside the facility and inside along the hallway. Hand sanitizer was also observed. LPA observed sufficient PPE supplies for residents and staff. LPA advised the administrator to review their mitigation plan with all staff to ensure all visitors are thoroughly screened upon entry.

Food Inspection: LPA observed there to be sufficient stock of one-week non-perishable foods and two-day perishable foods. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers in the kitchen. Sharps are kept locked in a kitchen drawer. Medications are in a centrally stored and locked in two kitchen cabinets. Smoke detectors/carbon monoxide were located throughout the facility and at 11:00 a.m. they were tested and appeared operational. Resident rooms: There are 4 bedrooms designated for resident use. 2 bedrooms are designated for live-in staff. All bedrooms are properly furnished, have appropriate bedding, linens and all had trash cans with lids. Auditory alarms were placed on doors due to dementia residents in care.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa RuizTELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: A PLUS ELDERLY CARE
FACILITY NUMBER: 197606875
VISIT DATE: 01/26/2022
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Bathrooms: The hot water temperature measured at 119.8F. LPA observed appropriate hand washing signs posted in each bathroom, grab bars and non-skid mats. Residents have sufficient amounts of supplies for personal hygiene. The garage is attached to the home and was observed to be inaccessible to residents. Laundry service is located in the garage and theres enough linens available to change weekly or more if need. Outside areas: LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. There are no bodies of water.

No deficiencies observed at this time. Exit interview conducted and report signed and delivered.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Melissa RuizTELEPHONE: (818) 401-7980
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
LIC809 (FAS) - (06/04)
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