198320215-11-18-2023-11-AS-DESA-CXQ2XM-20231118164723

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198320215
Report Date: 11/18/2023
Date Signed: 11/18/2023 04:47:27 PM

Document Has Been Signed on 11/18/2023 04:47 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 III		FACILITY NUMBER:	198320215
ADMINISTRATOR:	WELLS, NICHOLAS		FACILITY TYPE:	740
ADDRESS:	2110 OAK STREET		TELEPHONE:	(510) 384-3431
CITY:	SANTA MONICA	STATE: CA	ZIP CODE:	90405
CAPACITY:	6	CENSUS: 3	DATE:	11/18/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	WELLS, NICHOLAS		TIME COMPLETED:	05:00 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	On 11/18/2023 at 2 pm Licensing Program Analyst (LPA) David España conducted an unannounced Required-1-year annual visit. Upon arrival at the facility, LPA España conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection (No COVID-19 cases). LPA verified that the facility has an approved mitigation plan report. LPA was granted access and allowed to enter the facility to conduct the inspection. The requested capacity is for 6 clients, 1 non-ambulatory, 5 bedridden. Facility has a dementia care plan in place. LPA was greeted and accompanied on inspection by House Manager, Paige Danielle Esquivel. The facility is licensed for a Residential Care for the Elderly (RCFE) and serves age range 60 and over, approved for six (6) non-ambulatory, of which five (5) may be bedridden in rooms #1, #3 and #4 only, hospice waiver approved for five (5). Facility has 4 resident bedrooms, 2 shared bedrooms, 2 private bedroom, each shared room has a half bath ½, living room/dining room and kitchen. Facility is a single-story house. The client bedrooms are spacious and will easily accommodate the client's furnishings. There is a shaded yard with an umbrella, table and chairs. Outdoor passageways, walkways, driveways, steps and patios are free from obstructions. LPA did not observe hazards, such as ladders, gardening tools and/or motorized equipment in the front, back and/or side areas of the facility. LPA observed four resident bedrooms, three bedrooms are for bedridden and one bedroom is for non-ambulatory. Bedroom 2 has two beds, two chairs, two nightstands, overhead lighting, closet and two dressers with several drawers. Bedrooms 1 and 4 have one bed, one chair, one-night stand, overhead lighting, closet or wardrobe and a dresser with several drawers. Bedrooms 2 and 3 have two beds, two chairs, two nightstands, overhead lighting, and dressers with several drawers. All drawers comply with the requirement of 8 cubic feet of space and there was ample closet space. Continued on 809-C

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2023

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
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: A CARING TOUCH BOARD AND CARE III	FACILITY NUMBER: 198320215
	VISIT DATE: 11/18/2023

NARRATIVE

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There are grab rails next to both the toilets and the showers as well as nonskid mats in showers. LPA observed adequate lighting in hallway leading to bathrooms via nightlights.

The facility has an activity calendar and provides puzzles, origami, painting, other games and papercrafts as well as a karaoke machine, and chair dancing. Outside activity area is properly enclosed with self-closing latches and all doors have auditory devices to monitor exits. LPA's did not observe any pets or bodies of water at the facility. Fire Clearance was approved on 6/16/2021 for 5 bedridden client and 1 non-ambulatory clients with rooms one (1), three (3) and (4) four approved for bedridden.

The fire drill was conducted on 10/16/2023.

LPA did not observe pad locks or other mechanisms which may be obstructions for safe and quick egress during an emergency on side gates and front exits. All mandated inspection control posters were posted.

No deficiencies were observed during today's inspection.

An exit interview was conducted with House Manager, Paige Danielle Esquivel and a hard copy of the report was furnished.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2023

LIC809 (FAS) - (06/04)

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