198602861-10-12-2023-11-AS-LMOA-CWJUTF-20231012155153

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602861
Report Date: 10/12/2023
Date Signed: 10/12/2023 03:52:01 PM

Document Has Been Signed on 10/12/2023 03:52 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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME:	BEST PLACE HOME CARE		FACILITY NUMBER:	198602861
ADMINISTRATOR:	NAMOC, MARYLOU		FACILITY TYPE:	740
ADDRESS:	23736 PRESIDENT AVENUE		TELEPHONE:	(310) 784-1986
CITY:	HARBOR CITY	STATE: CA	ZIP CODE:	90710
CAPACITY:	6	CENSUS: 6	DATE:	10/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	MARYLOU NAMOC		TIME COMPLETED:	04:00 PM

NARRATIVE

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On 10/12/2023, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Caregivers Letecia Barber and Susan Adeva and explained the purpose of the visit. At around 11:00 AM, Administrator Marylou Namoc arrived and joined the visit.

The facility is licensed to operate for six (6) non-ambulatory elderly residents ages 60 and above. The facility is approved for one (1) bedridden and two (2) hospice. The facility is a single-story structure located in a residential neighborhood. The facility consists of the following: five (5) resident's rooms, two (2) bathrooms, a living room area, dining area, and kitchen. There is an attached garage with access through the door prior to entering the facility or the garage door. The washer and dryer are located in the garage. There is a shaded patio area with ample seating area for the residents. The facility does not handle residents’ cash resources. Facility Annual Fees are current during today’s visit. Administrator's certificate expires 6/25/2024.

At around 10:00 AM, LPA toured the inside and outside grounds of the facility with Caregiver Letecia Barber and Marylou Namoc. Carbon monoxide and smoke detectors were tested and found to be operable. Fire extinguishers were last serviced on 7/5/2023. The last facility fire drill was on May 20, 2023. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, and toxins were stored and not accessible to clients. The kitchen was inspected and there are sufficient two-day perishable and seven-day non-perishable food supplies.

There are no pools or bodies of water on the premises. There are no firearms on the premises or other dangerous weapons. Centrally stored medications are locked in a cabinet located in the medication room. The first aid kit has all required supplies. The facility has a written emergency disaster plan posted in the living room. The facility is maintained at a comfortable temperature. LPA observed the hot water temperature in the common bathroom was 116.1 degrees Fahrenheit. There are working lights or lamps in each room at the time of visit. There are grab bars for each toilet and shower used by residents. Showers have non-skid floors.

Report Continued in LIC 809-C

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

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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Document Has Been Signed on 10/12/2023 03:52 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BEST PLACE HOME CARE	FACILITY NUMBER: 198602861
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87555(b)(8)

General Food Service Requirements

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review the licensee did not comply with the section cited above. At around 10:08 AM, LPA Lourdes Montoya observed expired hamburger buns, Kroeger soft wheat bread, hotdog buns and guerrero tortillas inside the pantry. The hamburger buns expired on 9/21/23. The Kroeger soft wheat bread expired on October 6, 2023. The hotdog buns expired on 9/17/23. And the Guerrero tortillas expired on May 12, 2023. This poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/20/2023
	Plan of Correction
1 2 3 4	The administrator disposed all expired bread and tortillas. Administrator shall review the section cited above and shall conduct an in-service training to all staff. Administrator shall submit a proof of correction to CCLD via email to lourdes.montoya@dss.ca.gov.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/12/2023 03:52 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BEST PLACE HOME CARE	FACILITY NUMBER: 198602861
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87355(e)(2)

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing, or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, record review, the licensee did not comply with the section cited above. LPA Lourdes Montoya observed a caregiver (S3) is not associated to the facility. The administrator verbally confirmed S3 is not associated to the facility. Per review of S3's timesheet, S3 worked at this facility on the following dates: 9/6, 9/7, 9/14, 9/21, 9/27, 9/28, 10/4, 10/5, 10/11, 10/12. This poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/13/2023
	Plan of Correction
1 2 3 4	Accoording to the facility Administrator, S3 is only a reliever and S3 is today's last day of work. S3 left the facility at around 11:30 AM. This citation was corrected during the visit.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

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 ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: BEST PLACE HOME CARE	FACILITY NUMBER: 198602861
	VISIT DATE: 10/12/2023

NARRATIVE

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LPA requested a copy of the facility's liability insurance certificate. Administrator will email the binder.

LPA observed the following deficiencies:

1. LPA Lourdes Montoya observed a caregiver (S3) is not associated to the facility. The administrator verbally confirmed S3 is not associated to the facility. S3 stated S3 began working at the facility in September 2023.

2. At around 10:08 AM, LPA Lourdes Montoya observed expired hamburger buns, Kroeger soft wheat bread, hotdog buns and guerrero tortillas inside the pantry. The hamburger buns expired on 9/21/23. The Kroeger soft wheat bread expired on October 6, 2023. The hotdog buns expired on 9/17/23. And the Guerrero tortillas expired on May 12, 2023

Deficiencies are being cited based on LPA observations, interviews conducted and records review in accordance with the California Code of Regulations, Title 22, see LIC809D. Civil penalty is being assessed.

An exit interview was conducted, Plans of Corrections were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left wit Administrator Marylou Namoc.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lourdes Montoya	TELEPHONE: (510) 725-7918
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

LIC809 (FAS) - (06/04)

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