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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609913
Report Date: 02/01/2024
Date Signed: 02/01/2024 03:33:23 PM

Document Has Been Signed on 02/01/2024 03:33 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 IIFACILITY NUMBER:
197609913
ADMINISTRATOR:GUINTO, ALMAFACILITY TYPE:
735
ADDRESS:9037 EAST AVENUE R10TELEPHONE:
(661) 874-6390
CITY:LITTLEROCKSTATE: CAZIP CODE:
93543
CAPACITY: 4CENSUS: 4DATE:
02/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Alma GuintoTIME COMPLETED:
03:40 PM
NARRATIVE
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Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility at approximately 10:45 am. Upon entry LPA Smith disclosed to staff the purpose of the visit. The administrator was not present at the facility and was contacted by staff.

LPA conducted a tour of the physical plant at approximately 11:10 am to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

Common areas were observed for the ability to safely serve the needs residents. These included the kitchen and livingroom dining room combination. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed to be clean with sufficient seating for the residents.

LPA reviewed the food service areas, food storage and supply (perishable and nonperishable foods). There was sufficient non-perishable foods but not a sufficient supply two (2) days of perishable food observed. LPA observed rotting celery in refrigerator and in blue basket on counter: sprouting, shriveling-wrinkled potatoes with a green tinge. Staff discarded vegetables at time of visit. The refrigerator in garage is stocked with meats and frozen foods such as corndogs.

Resident medications are locked kitchen cabinet and sharps locked in two (2) kitchen drawers. Medications and sharps observed to be locked and inaccessible to residents in care. First aid kit stored in medication cabinets. Toxins are stored and locked in garage cabinets. There is one (1) fire extinguisher attached to wall in the kitchen and observed to be charged.

Laundry room is located in garage. The appliances observed to be functional.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2024
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 02/01/2024 03:33 PM - It Cannot Be Edited


Created By: Tihesha Smith On 02/01/2024 at 02:40 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GUINTO HOME CARE II
FACILITY NUMBER: 197609913

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80076(a)(18)
Food Service
(a) In facilities providing meals to clients, the following shall apply: (18) All food shall be protected against contamination. Contaminated food shall be discarded immediately.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above as LPA observed rotting celery in refridgator and in blue basket on counter: sprouting, shriveling-wrinkled potatoes with a green tinge which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/02/2024
Plan of Correction
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Vegetables were discarded at time of visit.
Type A
Section Cited
CCR
85076(d)(1)
Food Service
(1) Supplies of staple nonperishable foods for a minimum of one week and fresh 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
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Based on observation the licensee did not comply with the section cited above as LPA observed a low supply of two day perishable food which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/02/2024
Plan of Correction
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Administrator/Licensee with provide receipt and pictures of groceries by Poc date: 02/02/24
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:Naira Margaryan
LICENSING EVALUATOR NAME:Tihesha Smith
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2024


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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GUINTO HOME CARE II
FACILITY NUMBER: 197609913
VISIT DATE: 02/01/2024
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(Cont from 809)
The facility has four (4) bedrooms and two (2) bathrooms: with three (3) bedrooms for residents and one (1) staff room.

The resident bedrooms were properly furnished with sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPA observed a supply of linens in hall closet.

Each bathroom has the following items available: hand soap, paper towels, and trash cans. The hot water temperature was measured for the two (2) bathrooms to ensure it is within the required range for residents’ comfort and safety. The water temperature range was between 107.8- and 111.8 -degrees Fahrenheit.

Backyard has the following: Covered patio with various table and chair options with sufficient seating for residents.

Smoke detectors/carbon monoxide detector were tested and operable at time of visit.

At approximately 1:45-2:35 pm, LPA reviewed two (2) staff files and four (4) resident files. Staff files had the appropriate trainings to include First aid and CPR. Four (4) out of four (4) resident files included Individual Program plans, admission agreements. Staff and resident interviews conducted from 2:45-3:20 pm.

Deficiencies cited on 809-D.

Exit Interview Conducted /Appeals/Copy of the Report Issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024
LIC809 (FAS) - (06/04)
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