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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198320082
Report Date: 06/20/2023
Date Signed: 06/20/2023 12:05:48 PM


Document Has Been Signed on 06/20/2023 12:05 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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754



FACILITY NAME:A CARING TOUCH BOARD AND CARE IIFACILITY NUMBER:
198320082
ADMINISTRATOR:WELLS, NICHOLASFACILITY TYPE:
740
ADDRESS:2108 OAK STTELEPHONE:
(510) 384-3431
CITY:SANTA MONICASTATE: CAZIP CODE:
90405
CAPACITY:6CENSUS: 6DATE:
06/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Paige EsquivelTIME COMPLETED:
12:15 PM
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On 06/20/23 Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced annual required visit using the New Care Inspection Tool. LPA met with Paige Esquivel The purpose of today’s visits was explained. The facility is a single-story house. Facility is licensed for 6 clients, 3 non-ambulatory residents and 3 bedridden residents. The facility has an approved hospice waiver for 6 residents. The facility currently has 6 non-ambulatory residents, who are residing in the facility. All the (6) residents are diagnosed with Dementia at the facility. There are 2 receiving Home Health and 2 receiving Hospice Services. The facility does not handle residents’ money.

LPA toured the physical plant, inspected food service, reviewed staff records, and reviewed resident files for medical status. The facility conducted a fire drill on 05/22/23. The facilities consist of 5 resident bedrooms, 5 bathrooms, living room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Bathrooms are clean, sanitary, and fixtures are working properly, the bathrooms grab bars are secure and non-skid mats in place. The hot water temperature properly measured at 109. 8F. Resident bath towels, toiletries, and personal hygiene supplies were adequately stocked. LPA observed the facility’s infection control practices. PPE supplies are available to staff and residents and addition supplies are stored. Common areas were clean and hazard free. All doorways were free of obstructions. All doors have auditory alarms, with self-closing latches to monitor exits. The facility Fire Clearance was approved. The facility Liability Insurance is current.

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Antonine RichardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2023
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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: A CARING TOUCH BOARD AND CARE II
FACILITY NUMBER: 198320082
VISIT DATE: 06/20/2023
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Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Seven dual Smoke detectors and Carbon monoxide detectors were tested and found to operating properly. The First Aid kit is fully stocked. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. There is a shade yard with umbrella, table and chairs.

No deficiencies cited during this visit under California Code of Regulations, Title 22, Division 6, Chapter 8.

An exit interview was conducted and a copy of the report was provided to Paige Esquivel.

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Antonine RichardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
LIC809 (FAS) - (06/04)
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