197608711-11-1-2021-31-AS-TCAS-C8CPMG-20211101112619

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608711
Report Date: 11/01/2021
Date Signed: 11/01/2021 11:27:35 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:	FOOTHILL RETIREMENT CARE HOME		FACILITY NUMBER:	197608711
ADMINISTRATOR:	JINA MALEKSARKISSIANS		FACILITY TYPE:	740
ADDRESS:	6720 SAINT ESTEBAN STREET		TELEPHONE:	(818) 353-3350
CITY:	TUJUNGA	STATE: CA	ZIP CODE:	91042
CAPACITY:	72	CENSUS: 40	DATE:	11/01/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Roy Manasan		TIME COMPLETED:	11:40 AM

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Licensing Program Analyst (LPA) Tuesday Cabiness arrived at the facility to conduct an unannounced infection control inspection/visit. Upon arriving, LPA was greeted by the front desk receptionist, who asked LPA to sign in and use electronic thermometer for temperature reading. A portable sink for hand washing was located at the front entrance. LPA met with Administrator Roy Manasan, and informed him the reason of the visit. There have not been any active or past COVID cases at the facility since January 2021. There are 99.0% of residents vaccinated, and all staff have been vaccinated. The current census is (40). LPA observed staff and residents to have full mask covering, and residents were virtually exercising in the common area. COVID-19, CDC, Department of Public Health, and Licensing postings, in various languages, were visible seen and posted on the walls throughout the facility. Facility also has a shoe cleaning station, that sterilizes the soles.

The infection control inspection began with the Administrator, who escorted LPA throughout the facility. The facility has (3) living quarters for residents: assisted living (24 residents), memory care (12 residents), and independent (4 residents). 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 and housekeeping cleaning common areas throughout the day. There are community updates provided to residents, to communicate any new changes or procedures that are being implemented, pertaining to COVID-19. Currently, the Administrator has requested all residents to continue wear masks daily.

The Administrator reported to LPA, the facility has documentation of all vaccination records and other pertinent information pertaining to COVID-19, in staff and resident files. All new employee hires and new resident admits, will be properly screened, and must provide a negative COVID test. The facility has also implemented vaccination policy for new-hires.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021

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: FOOTHILL RETIREMENT CARE HOME	FACILITY NUMBER: 197608711
	VISIT DATE: 11/01/2021

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New admits must provide a negative test, prior to entering the facility; and facility re-test after admitting. The facility continues to surveillance test, the (1) resident who is not vaccinated. The test is conducted in-house. If there are any signs or symptoms from residents or staff, the facility has a rapid test kits in place, and uses internal pharmacy for results. Administrator reported to LPA, that he continues to receive all departmental emails. Facility continues to provide and conduct in-service training to staff in relation to COVID-19 and other required training. There is a current sick leave policy available for full time staff. The facility does not have staffing issues; due to having per diem staff available to work for shift that are available. There are designated rooms for potential positive COVID residents.

PPE supplies were inspected, and Administrator reported to LPA that the supplies are kept in the storage area, and weekly stocked with supplies. 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.

Exit interview was conducted and copy of report provided.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 11/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2021

LIC809 (FAS) - (06/04)

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