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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608877
Report Date: 12/07/2022
Date Signed: 12/07/2022 11:51:01 AM


Document Has Been Signed on 12/07/2022 11:51 AM - 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:ALORA'S HOME CARE, INC.FACILITY NUMBER:
197608877
ADMINISTRATOR:EVANGELINE DE MATAFACILITY TYPE:
740
ADDRESS:22833 FRISCA DRIVETELEPHONE:
(661) 296-3244
CITY:VALENCIASTATE: CAZIP CODE:
91354
CAPACITY:6CENSUS: 6DATE:
12/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Christopher Mendoza, Administrator TIME COMPLETED:
12:00 PM
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At 10:20am, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA observed COVID-19 signage posted outside on the front door and along the main entrance. LPA explained the reason for the visit and asked the staff to contact the Administrator. Administrator arrived shortly after and at 10:30am LPA conducted a tour of the physical plant and observed the following:

Facility is a Residential Care Facility for the Elderly which was licensed for six (6) non-ambulatory residents. Facility has four bedrooms, two bathrooms and one staff room. Facility has been approved for a hospice waiver for two (2) residents. LPA was able to tour the home and did not observe any immediate health and safety concerns. Sufficient PPE supplies were observed. Smoke detectors and carbon monoxide monitors were observed to be functional. Facility maintains a temperature of 75°F. LPA observed there to be sufficient stock of one-week non-perishable foods and two-day perishable foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Sharps, cleaning supplies and medications are centrally stored and are kept locked in various kitchen cabinets and drawers. Bedrooms are appropriately furnished and have appropriate lighting. Bathrooms have soap, paper towels and hand washing signs were observed. The hot water temperature measured at 119.8°F. Extra towels and linens were readily available.The fire extinguisher was observed in the garage area and was last serviced on 10/20/2022. Laundry area is also located in an attached garage and kept locked and inaccessible to clients. Facility has a swimming pool that is fenced all around with a gate and kept locked at all times. The fence surrounding the swimming pool is approximately 5 feet high all around its parameters. LPA also observed a clean covered patio and backyard furniture to accommodate the six (6) residents.

No deficiencies issued during today’s visit. Report was signed and delivered. An exit interview was conducted.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela PanushkinaTELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:
DATE: 12/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/07/2022
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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