198205144-7-11-2022-11-AS-LMOA-CG8PJ3-20220711112049

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198205144
Report Date: 07/08/2022
Date Signed: 07/11/2022 11:20:57 AM

Document Has Been Signed on 07/11/2022 11:20 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	SANTA FE HOME CARE HOMES		FACILITY NUMBER:	198205144
ADMINISTRATOR:	ANGELIQUE GRADNEY		FACILITY TYPE:	740
ADDRESS:	2340 SANTA FE AVENUE		TELEPHONE:	(424) 488-2079
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90501
CAPACITY: 6		CENSUS: 3	DATE:	07/08/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	CATHERINE ESPINO		TIME COMPLETED:	05:00 PM

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On 7/8/2022, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced required annual visit with a primary focus on Infection Control measures using the new CARE Inspection Tools. Upon arrival at the facility, LPA Montoya called the facility, spoke with Administrator Angelique Gradney and conducted a risk assessment. Based on the assessment, the facility is clear of Covid-19 infection. The facility is licensed for four (4) ambulatory residents and two (2) Nonambulatory residents. There are three residents and two caregivers present during the visit. Upon arrival, LPA met with Staff Catherine Espino (Assistant to the Administrator) who assisted with the visit.

LPA Montoya and Staff Espino toured the inside and outside grounds of the facility. LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the facility entrance and visitors’ log. PPE supplies are readily available to staff, and an additional 30-day supply of PPE; sufficient paper, cleaning, and disinfecting supplies were observed. The facility’s designated visitation areas are the front patio, back patio, and living room. LPA observed staff and residents maintain 6 feet physical distancing, and each staff wears a face covering.

Based on LPA’s record review and interview with Staff Espino, all four residents and all four staff have been vaccinated; N95 Fit testing has been completed and facility staff have been given training on Covid-19 Infection Control and Prevention training. The facility conducts Covid-19 testing for all staff and residents every week.

All rooms were inspected. Beds in shared bedrooms are 6 feet apart/3 feet head-to-toe apart. Adequate lightings and storage for residents’ personal belongings were observed.

There are no security bars or weapons on the premises. Resident bathrooms were checked, and sufficient liquid soap and paper towels were observed. Toilets and water faucets worked properly, grab bars were

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SANTA FE HOME CARE HOMES	FACILITY NUMBER: 198205144
	VISIT DATE: 07/08/2022

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secure, and the shower was free of mold/mildew. A comfortable temperature was maintained in the facility. The water temperature is measured 115.0 degrees Fahrenheit. The hallways, living room, and four out of five resident bedrooms have working smoke detectors and they are all interconnected and operational. Two carbon monoxide detectors located in hallways were observed. A fire extinguisher located in the kitchen/dining area was last serviced on 8/12/2021.

LPA checked the kitchen area. LPA observed an adequate two-day supply of perishable foods and a one-week supply of nonperishable food supply. The First Aid kit was available. Outside grounds were toured, and no bodies of water were observed. Walkways around the home were clear of hazards. Common areas were clean and clear of hazards; doorways were free of obstructions.

Due to time constraints and technical difficulty, LPA is unable to issue citations for all deficiencies observed during today's visit. LPA will return to the facility to issue the following citations:

1. A nonresident sleeping regularly in resident bedroom #5.

2. No personnel records for Staff #1 and #2

3. Broken sliding door screen by the kitchen

4. The garage is filled with old furniture, scattered clothing, old furniture, crutches, wheelchairs, boxes, etc.

5. No records of daily temperature and Covid-19 symptoms checks for staff and residents.

6. Bedroom #5 is dirty and cluttered.

7. Bedroom #3 has no smoke alarm

8. Staff #1 and #2 have no criminal record clearances and not associated to the facility.

Exit interview was conducted and a copy of this report was provided to Staff Catherine Espino.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Lourdes Montoya
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022

LIC809 (FAS) - (06/04)

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