197610049-6-13-2023-31-AS-ADUA-CSRVRM-20230613164010

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197610049
Report Date: 06/13/2023
Date Signed: 06/13/2023 04:41:00 PM

Document Has Been Signed on 06/13/2023 04:41 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:	CASTLEMERE SENIOR HOME		FACILITY NUMBER:	197610049
ADMINISTRATOR:	JOSEPH-NURSE, VERONICA		FACILITY TYPE:	740
ADDRESS:	23216 VIA CALISERO		TELEPHONE:	(661) 481-0076
CITY:	VALENCIA	STATE: CA	ZIP CODE:	91355
CAPACITY:	6	CENSUS: 4	DATE:	06/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:58 AM
MET WITH:	Veronica Joseph-Nurse		TIME COMPLETED:	04:45 PM

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

At 10:00 AM Licensing Program Analyst (LPA), Abeye Duguma, conducted an unannounced annual inspection at the facility mentioned above. LPA was greeted by staff, Resty Angeles, who granted access to the facility. Shortly after the administrator, Veronica Joseph-Nurse, arrived and LPA explained the purpose for the visit.

Infection control: Facility has a mitigation plan (approved on 03/21/2021). Hand sanitizer was also observed. Administrator stated they have sufficient PPE supplies for residents and staff. LPA observed all trash can throughout the facility have fitted lids.

Kitchen: At approximately 11:00am 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 in care. The fire extinguisher was last serviced on 05/10/23.

Medications: At approximately, 11:25am LPA observed medications are centrally stored and locked in the cabinet, in a dining room area and inaccessible to residents in care.

Bedrooms: There are 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 11:55am LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. The hot water temperature measured 113.6°F.

LPA observed appropriate grab bars and non-skid mats. LPA observed appropriate hand washing signs posted in each bathroom.

(Cont. on LIC 9099-C)

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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: CASTLEMERE SENIOR HOME	FACILITY NUMBER: 197610049
	VISIT DATE: 06/13/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

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.

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

Outside areas: At approximately, 12:25pm LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents. There are no bodies of water.

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

No citations issued during this visit.

No health and safety issues noted during the visit.

Exit interview conducted. Copy of report issued to the Administrator.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2