197607032-4-10-2023-31-AS-TCAS-CQRSJA-20230410135449

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607032
Report Date: 04/10/2023
Date Signed: 04/10/2023 01:55:37 PM

Document Has Been Signed on 04/10/2023 01:55 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	BRIDGES OF HOPE & LOVE #3		FACILITY NUMBER:	197607032
ADMINISTRATOR:	ANNIE C. OBSEQUIO		FACILITY TYPE:	740
ADDRESS:	27736 SYCAMORE CREEK DRIVE		TELEPHONE:	(661) 263-6533
CITY:	VALENCIA	STATE: CA	ZIP CODE:	91354
CAPACITY:	5	CENSUS: 3	DATE:	04/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Mario Gurule		TIME COMPLETED:	02:00 PM

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Licensing Program Analyst (LPA) Tuesday Cabiness conduct Annual and infection/mitigation inspection. LPA was greeted by caregiver Joselyn Sekh, who allowed LPA to enter. There was (1) additional staff on duty, Nazrul Sekh. Administrator Mario Gurule was contacted and arrived at the facility shortly after. During the visit, LPA was made aware, that the facility had been sold, to the current Administrator Mario Gurule. According to information in FAS, the facility was sold, and a new application for the same address was approved. Personnel summary was verified; and all staff were not transferred to the new facility number. Administrator Mario will make sure that all staff are associated in the guardian system. The current census is (3). Facility license/sketch, grievance/complaint procedures, personal rights, Infection/Mitigation plan, Administrator certificate, emergency disaster plan, COVID/hand-washing signs, and complaint procedures was visibly posted.

A physical plant tour of the facility inside and outside was conducted with Administrator Mario Gurule. The following common areas: living, dining, kitchen, resident bedrooms, and bathrooms were inspected to ensure the facility was in compliance with Title 22 Regulations:

Kitchen: LPA observed a Licensing requirement of (7) day nonperishable, and (2) perishable, with extra refrigerator stocked with food, in the garage. Food was properly wrapped, and appliances were functional, clean, and in good repair. Chemicals, household supplies, and knives, that are stored in the kitchen and garage area were locked and secured. Living/dining: All indoor passageways were free from obstruction; inside temperature was comfortable, with adequate lighting, and all areas were clean and appropriately furnished for resident’s comfort. Bedrooms: The facility has (5) bedrooms; with (1) room for staff. All bedrooms were properly furnished and supplied with appropriate bedding and linens. There were sufficient linens observed and available; as well as personal hygiene products available for residents.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

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: BRIDGES OF HOPE & LOVE #3	FACILITY NUMBER: 197607032
	VISIT DATE: 04/10/2023

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Bathrooms: There are (2); all were clean, with soap and towels, grab bars, and non-skid mats. Hot water measured at 116.6. degrees Fahrenheit. Surrounding Grounds: There were no visible hazards; passageways were free from obstruction and gates were easily accessible to open. There was no swimming pools or other bodies of water. All exit doors have alarms; all were operating. Fire extinguisher fully charged. First aid kit furnished fully equipped. Smoke alarms and carbon monoxide detectors were tested and operating properly.

Record review: A complete record review of staff and residents were conducted. All required documents in files.

Infection/Mitigation Control Review: The common areas were observed to be clean, including resident rooms, and staff and visitor bathrooms. Soap and towels, and hand washing signs were visually posted. The facility has cleaning procedures and protocols in place, which include staff cleaning common areas throughout the day. The facility has documentation of all vaccination records for staff and residents. All new employee hires and new resident admits, will be properly screened, and provided a negative COVID test, prior to entering the facility; and must be fully vaccinated. If there are any signs or symptoms from residents or staff, the facility has a rapid test kits in place. The Administrator received departmental emails. Facility continues to provide and conduct training to staff in relation to COVID-19 and other required required training. There is a current sick leave policy, and they currently have no staffing issues. There are designated rooms for potential positive COVID residents; facility has private rooms.

PPE supplies were inspected and have over (30) day supply. The facility continues to implement the best practices for the facility; to ensure the health and safety of residents and staff. The facility is aware to report any changes with residents and staff to Licensing and there LPA, pertaining to positive COVID-19 cases.

No citation issued, exit interview and copy of report provided.

LPA will close facility in Licensing database, the next office day.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2023

LIC809 (FAS) - (06/04)

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