197608877-12-28-2021-31-AS-APAA-CA5VMQ-20211228153356

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608877
Report Date: 12/28/2021
Date Signed: 12/28/2021 03:34:43 PM

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:	ALORA'S HOME CARE, INC.		FACILITY NUMBER:	197608877
ADMINISTRATOR:	EVANGELINE DE MATA		FACILITY TYPE:	740
ADDRESS:	22833 FRISCA DRIVE		TELEPHONE:	(661) 296-3244
CITY:	VALENCIA	STATE: CA	ZIP CODE:	91354
CAPACITY:	6	CENSUS: 5	DATE:	12/28/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Evangeline De Mata, Administrator.		TIME COMPLETED:	03:50 PM

NARRATIVE

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At 1:20pm Licensing Program Analyst (LPA), Angela Panushkina, conducted an unannounced annual inspection at the facility mentioned above. Infection control: Upon arrival, LPA observed COVID-19 signage posted outside on the front door and along the main entrance. Upon entrance, LPA was not screened by staff #1 and was not asked any infection control questions. When LPA asked the staff what their screening procedure for visitors was, the staff stated they just made sure the visitor has a mask on and is vaccinated. LPA explained the reason for the visit and asked the staff to contact the Administrator. Administrator arrived at 2:00pm.

At 1:28pm a tour of the physical plant was conducted and LPA observed the following:

Kitchen: At approximately, 1:28pm LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents.

Smoke detectors/carbon monoxide. Dual smoke and carbon monoxide detectors were located throughout the facility, and at 2:30pm they were tested and observed to be operational.

Bedrooms: There are four (4) out of five (5) 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.

Bathrooms: At 1:40pm 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 119.2°F. LPA observed

appropriate grab bar and had non-skid mat. LPA observed appropriate hand washing signs posted in each bathroom. All trash cans in bathrooms had fitted lids to protect from cross contamination.
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: 12/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021

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: ALORA'S HOME CARE, INC.	FACILITY NUMBER: 197608877
	VISIT DATE: 12/28/2021

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Common Areas: The facility maintains a comfortable temperature at 76°F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. There is a fire extinguisher in the kitchen area was last serviced on 10/20/2021.

Outside areas: At approximately, 1:50pm LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. There is an in ground pool. The pool has five foot fencing completely surrounding it and is kept locked and inaccessible to residents. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents.

The garage: Laundry area is located in an attached garage and kept locked and inaccessible to clients. Extra PPE supplies and food storage was also observed.

Medications: At approximately, 1:30pm LPA observed medications are centrally stored and locked in the cabinet, by the kitchen area and inaccessible to residents in care.

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

Deficiencies were issued per CA code of Regulations Title 22 or Health and Safety Code. LIC809-D included with this report. Appeal rights discussed and copy of this report provided 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: 12/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021

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: ALORA'S HOME CARE, INC.	FACILITY NUMBER: 197608877
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/28/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87468.1(a)(2)

87468.1(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. 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 due to the staff not following the infection control mitigation plan which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 12/30/2021
	Plan of Correction
1 2 3 4	Administrator agreed to provide in house training, provide training materials and proof of sing in sheet for staff. Additionally, Administator will implement a visitation log and send proof to LPA by POC due date.

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: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2021

LIC809 (FAS) - (06/04)

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