197609961-2-15-2024-31-AS-LCAS-D2GSWN-20240215131437

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609961
Report Date: 02/15/2024
Date Signed: 02/15/2024 01:14:48 PM

Document Has Been Signed on 02/15/2024 01:14 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	A CARING TOUCH BOARD AND CARE		FACILITY NUMBER:	197609961
ADMINISTRATOR:	PAIGE ESQUIVEL		FACILITY TYPE:	740
ADDRESS:	10348 LARAMIE STREET		TELEPHONE:	(818) 477-2990
CITY:	CHATSWORTH	STATE: CA	ZIP CODE:	91311
CAPACITY:	6	CENSUS: 6	DATE:	02/15/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Paige Esquivel		TIME COMPLETED:	01:31 PM

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Licensing Program Analyst (LPA), Lorena Casillas, met with Administrator Paige Esquivel for an unannounced one (1) year Required visit for this facility.

At 9:45 am LPA arrived at the facility and was granted access by a Caregiver who then called the Administrator. Administrator arrived shortly after, and LPA explained the reason for the visit.

LPA observed that currently there are six (6) residents in care, four (4) are under hospice care of one (1) of which is bedridden and one (1) are ambulatory.

At 10:50 am, LPA conducted a tour of the facility, and the following was observed:

Infection control: The facility had submitted and approved Mitigation Plan and Infection Control Plan. Proper signs were observed inside along the hallway and in the restrooms.

Kitchen: At 11:00 am LPA toured the kitchen area and observed enough supplies of two (2) days perishables and seven (7) days of non-perishables at the facility. All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. There is a fire extinguisher in the kitchen area and it was last serviced on 07/14/2023.

Bedrooms: There are six (6) bedrooms designated for residents use. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Auditory alarms were tested and observed to be operational. Facility has awake staff at night.

Common Areas: The facility maintains a comfortable temperature at 74 °F. The living room and dining area appeared clean and were properly furnished. No obstructions or tripping hazards throughout the facility. LPA observed all trash cans throughout the facility have fitted lids.

Continued on LIC809-C

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena Casillas	TELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: A CARING TOUCH BOARD AND CARE	FACILITY NUMBER: 197609961
	VISIT DATE: 02/15/2024

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Bathrooms: LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet paper, soap and paper towels. The hot water temperature measured 113.9 °F. LPA observed appropriate grab bars and non-skid mats. LPA observed appropriate hand washing signs posted in each bathroom. All trash cans in bathrooms had fitted lids to protect from cross contamination.

Outside Areas: LPA toured the outside area of the facility. LPA also observed a clean covered patio and backyard furniture to accommodate the six (6) residents. There were no bodies of water observed.

Laundry: Laundry area is in a bathroom and LPA observed laundry soap to be locked and inaccessible to residents in care.

Garage: LPA observed an attached locked garage door inaccessible to residents. Extra supplies and food storage were also observed.

Smoke Detectors/Carbon Monoxide. Dual smoke and carbon monoxide detectors were located throughout the facility, and at 1:10 pm they were tested and observed to be operational.

Resident Files: LPA conducted a file review of resident records to ensure compliance of licensing forms.

Staff Files: LPA conducted a file review of staff records to ensure compliance of licensing forms.

Medications: LPA and Administrator reviewed medication and medication records for proper documentation.

Staff Interviews: At 12:38 pm LPA interviewed staff.

Client Interviews: At 11:30 am LPA interviewed clients.

Administrative: Annual fees are current. LPA collected Certificate of Liability Insurance, LIC500, and Resident Roster.

No citations issued during this visit. Exit interview conducted. Copy of report given to the Administrator.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena Casillas	TELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024

LIC809 (FAS) - (06/04)

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