197607393-3-20-2024-31-AS-ERIS-D3JSRC-20240320140607

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197607393
Report Date: 03/20/2024
Date Signed: 03/20/2024 02:06:14 PM

Document Has Been Signed on 03/20/2024 02:06 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:	DURANDO HOME INC.III		FACILITY NUMBER:	197607393
ADMINISTRATOR:	JAMES DURANDO		FACILITY TYPE:	740
ADDRESS:	36235 43RD STREET EAST		TELEPHONE:	(661) 917-4380
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93552
CAPACITY:	4	CENSUS: 3	DATE:	03/20/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Nancy Magallanes Silva		TIME COMPLETED:	02:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 03/20/2024 at 9:10 a.m. Licensing Program Analyst (LPA) Evelin Rios arrived at the facility mentioned above to conduct a Required Annual Inspection. LPA was greeted by Staff #1 (S1) who granted access. S1 called the Administrator James Durando and inform them LPA was at the facility. Administrator designee Nancy Magallanes Silva met LPA shortly after. LPA explained the reason for the visit. The inspection tool was used to complete the visit. This is a Residential Care Facility for the Elderly licensed for 4 ambulatory residents. This facility has accepted North Los Angeles County Regional Center clients that are under 60 years of age. Administrator James Durando arrived at the facility but had to leave and designated Nancy to sign today's report. At 9:25 a.m. LPA began a physical plant tour of the facility and the following was observed: Kitchen: LPA observed the kitchen to be clean and clear of clutter. All appliances were operative. Knives are kept locked in a kitchen cabinet inaccessible to residents. LPA observed 2-day perishable and 7-day non-perishable supply of food. The fire extinguisher was observed by the kitchen fully charged with service date of 04/10/2023. Dining / Living Area: The dining and living area were well lit, clean and clear of clutter. Furniture appeared clean and in good repair. A fireplace located in the dining area was not in use and secured with a glass screen. LPA observed required postings by the dining area. Bedrooms: There are four (4) bedrooms designated for resident use. One (1) out of the four (4) rooms is currently vacant. All resident rooms are furnished with required lighting, dresser, chair, bed, and linens. There are extra linens in a hallway closet. (Continued on LIC809-C)

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

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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Document Has Been Signed on 03/20/2024 02:06 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: DURANDO HOME INC.III	FACILITY NUMBER: 197607393
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87303(e)(2)

Maintenance and Operation

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in two (2) out of two (2) bathrooms used by residents by having the hot water temperature read below the regulated hot water temperature less than 105 degree F which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/21/2024
	Plan of Correction
1 2 3 4	Licensee will adjust the water temperature to be no less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). Licensee will send a picture to LPA with thermometer reading the water temperature in both bathroom sink faucets.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: DURANDO HOME INC.III	FACILITY NUMBER: 197607393
	VISIT DATE: 03/20/2024

NARRATIVE

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Bathrooms: There are two (2) bathrooms designated for resident use. One (1) bathroom is located in the vacant bedroom. The main bathroom is accessible to all the residents. Both bathrooms were well lit, clean, had grab bars, nonskid showers and trash bins with lids. LPA observed a sufficient supply of hand soup, paper towels and toilet paper. At approximately 12:55 p.m. hot water temperature in both bathrooms measured between 94 - 98 degrees F.

Surrounding Grounds: LPA discussed with administrator the sun rooms that are currently storing furniture must be accessible for residents use or designated as storage areas if not used by residents. LPA observed the facility to have sufficient space to accommodate activities. There were no visible hazards, and passageways were free from obstruction. There is a covered patio to provide shade and appropriate outdoor seating for residents. LPA observed a drained pool with a perimeter fence kept locked.

Laundry Room: Laundry room in garage is kept locked. LPA observed a washer and dryer that appeared operative. Detergents and cleaning solutions are kept in looked in the garage by the washer and dryer.

Medications: Centrally stored medications are maintained locked in a kitchen cabinet. Centrally Stored Medication And Destruction Records were reviewed for proper documentation. Facility maintains a Medical Administration Record (MAR) that is maintained manually.

Resident/Staff files: At 10:27 a.m. LPA reviewed three (3) out of three (3) resident records to insure compliance. At 11:57 a.m. LPA reviewed four (4) staff records, two staff from the morning shift and two staff from the night shift to insure compliance.

LPA observed smoke alarms through out the facility. Smoke detectors are hard wired and interconnected. Alarms were blinking with a light indicating they were operational. LPA discussed with the administrator, facility will obtain a record that smoke detectors are tested and operational by a certified professional. LPA observed one carbon monoxide detector in the hallway and was observed operational.

Deficiencies were observed during todays visit (refer to LIC809-D). Exit interview conducted. Copy of report and appeals provided.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

LIC809 (FAS) - (06/04)

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