197608731-7-7-2022-31-AS-APAA-CG4RNM-20220707131034

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608731
Report Date: 07/07/2022
Date Signed: 07/07/2022 01:11:33 PM

Document Has Been Signed on 07/07/2022 01:11 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:	GUINTO HOME CARE INC.		FACILITY NUMBER:	197608731
ADMINISTRATOR:	ALMA S. GUINTO		FACILITY TYPE:	740
ADDRESS:	38645 EASTON STREET		TELEPHONE:	(661) 441-2814
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93552
CAPACITY:	5	CENSUS: 2	DATE:	07/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Alma Guinto, Administrator		TIME COMPLETED:	01:25 PM

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At 10:20am Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced annual inspection at the above facility. LPA met with two (2) staff members Abelardo and Virginia Guinto who granted access to home. This is a 4 bedroom, 2 bathroom, single story family residence that includes a living room, dining area, kitchen, laundry room and attached garage. LPA toured the entire facility with the Administrator who arrived shortly after, and observed the following:

Infection control: LPA Panushkina reviewed facility mitigation plan (approved on 03/30/21) to make sure licensee was following current infection control recommendations. Upon arrival, LPA was screened by a staff member, but was not asked any infection control questions. LPA had to prompt and guide staff through the screening process.

Kitchen: At 10:30am LPA conducted a food inspection tour and found the following: The facility doesn't have sufficient supply of 2 days perishable foods. LPA observed all knives locked and inaccessible to residents in care. Fire extinguisher was last serviced on 03/11/2022.

Medications: Medications are centrally stored in the kitchen cabinet and kept locked and accessible to residents.

Bedrooms: There are three (3) bedrooms designated for residents' use and have sufficient lighting. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Auditory alarms were tested and observed to be operational.

Continue on LIC809-C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GUINTO HOME CARE INC.	FACILITY NUMBER: 197608731
	VISIT DATE: 07/07/2022

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Bathrooms: At 11:00am LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. The hot water temperature measured at 108°F. LPA observed appropriate grab bar and had non-skid mats. LPA observed appropriate hand washing signs posted in each bathroom. Trash can in bathrooms need lids to protect from cross contamination.

Common Areas: The facility maintains a comfortable temperature at 77°F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility.

The garage is attached to the home and is kept locked and inaccessible to residents.

Smoke detectors/carbon monoxide. Dual smoke and carbon monoxide detectors were located throughout the facility, and at 11:25am they were tested and observed to be operational.

Surrounding Grounds: At approximately, 11:30am LPA toured the outside area of the facility. LPA observed various items stored in the backyard which need to be stored out of the way. LPA observed an old dryer, a stack of wood beams and a blue, barrel. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents. Facility has an appropriate outdoor furniture, with a covered shaded area for residents. There are no bodies of water. Gate was unlocked and easily accessible to open.

Administrative: LPA collected Certificate of Liability Insurance and LIC.500.

Deficiencies issued per Title 22.

Exit interview conducted, appeal rights discussed and copy of this report issued to the Administrator.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/07/2022 01:11 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GUINTO HOME CARE INC.	FACILITY NUMBER: 197608731
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/07/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87470(a)

87470(a) Infection Control Requirements: (a) A licensee shall ensure that infection control practices are maintained as follows. 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. The licensee failed to follow the infection control protocol on screening procedures. Staff were not familiar with screening procedures and no symptom screening questions have been asked, which poses a potential health, safety to persons in care.
	POC Due Date: 07/14/2022
	Plan of Correction
1 2 3 4	Licensee agreed to train all staff on Mitigation Plan and Infection Control which includes screening. Staff sign-in sheet and training materials shall be e-mailed to LPA by POC date.

Type B

Section Cited

CCR

87555(b)(26)

87555(b)(26) General Food Service Requirements (b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. 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 by not having sufficient supply of perishable food at the facility which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 07/14/2022
	Plan of Correction
1 2 3 4	Licensee/Administrator will purchase non-perishable food for the facility, copy of the receipt and photo of the purchased food will need to be submitted as POC.

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: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC809 (FAS) - (06/04)

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