198602966-4-14-2023-28-AS-THEA-CQVLWZ-20230414090757

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602966
Report Date: 04/13/2023
Date Signed: 04/14/2023 09:08:22 AM

Document Has Been Signed on 04/14/2023 09:08 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	CASTANA HOME CARE		FACILITY NUMBER:	198602966
ADMINISTRATOR:	HERNANDEZ, FLORANTE		FACILITY TYPE:	735
ADDRESS:	5629 CASTANA AVE		TELEPHONE:	(310) 418-0718
CITY:	LAKEWOOD	STATE: CA	ZIP CODE:	90712
CAPACITY: 4		CENSUS: 4	DATE:	04/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:13 AM
MET WITH:	Florante Hernandez		TIME COMPLETED:	12:45 PM

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Licensing Program Analyst (LPA) Tena Herrera conducted the required annual inspection. LPA arrived unannounced and met with Florante Hernandez (Administrator) who assisted with the visit. The facility is licensed to serve 3 ambulatory and 1 non-ambulatory clients ages 18 to 59 years old.

The facility is in a residential area. A tour of the single-story facility includes: living room, family room, dining area, kitchen, 4 client bedrooms, 2 bathrooms, laundry closet, attached garage, front yard, and backyard.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting residents’ medications. Staff are still cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan posted by the entrance.

Physical Plant & Environment Safety: There are 4 client bedrooms, 2 bathrooms, living room, family room, kitchen, dining area, laundry closet, attached garage, front yard and backyard. All bathrooms are clean, operational and observed with shower mats. One of the bathrooms have grab bars for the non-ambulatory client. Clients’ bedrooms were checked and closet/drawer space to accommodate each client comfortably was available. The backyard is free of debris/hazards and the outdoor and passageways are free of obstruction. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available. The hot water temperature was tested in the bathrooms and kitchen, measurement's were 108.5, 111.2, and111.7 degrees F which are within the required range of 105-120 degrees. All storage areas for cleaning solutions, toxins, knives, and hazardous items are in a secured locked cabinet located in the kitchen and inaccessible to clients. The last Fire/Emergency Drill was conducted on 02-04-2023. Smoke detectors and carbon monoxide detectors are operable and in compliance. The fire extinguishers was observed in the kitchen area and garage and are fully charged.
(Continued on 809-C)

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CASTANA HOME CARE	FACILITY NUMBER: 198602966
	VISIT DATE: 04/13/2023

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Operational Requirements: There are currently 3 ambulatory residents and 1 non-ambulatory resident residing at the facility.
Staffing: There appears to be sufficient staffing at all times in the facility. There are 3 administrators at the facility all with valid certificates. (Florante Hernandez, Ruvy Pelesasa, Jennifer Hernandez)
Personnel Records-Training: Staff has criminal record clearance. Staff files are maintained at the facility located in the garage. Staff have current CPR/first aid training and sufficient on-going training.
Resident Rights-Information: Residents personal rights poster is posted in the living room and is clearly visible.
Resident Records-Incident Reports: Resident files are kept in a cabinet located in the kitchen/dining and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan.
Food Service: The kitchen was observed for the ability to prepare and serve food. LPA observed an appropriate food supply of two (2) days of perishables and one week (7 days) of non-perishables. There was additional perishables and non-perishables located in the garage. Garage has an additional refrigerator.
Health Related Service: Staff designated to administer medication has the proper annual training on file. Medication is properly labeled and are centrally stored in a locked closet and are in their original containers. During the visit today, LPA reviewed all 4 residents' medication no issues were observed.
Incidental Medical & Dental: All medications for clients are kept locked and inaccessible to other clients.
Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites.
Emergency Intervention: Residents at this facility do not have restraints nor do they require the use de-escalation techniques.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit.

Exit interview held and a copy of the report was provided to administrator Florante Hernandez.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC809 (FAS) - (06/04)

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