300611895-7-19-2022-22-AS-ETAA-CGGNYR-20220719105309

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 300611895
Report Date: 07/19/2022
Date Signed: 07/19/2022 10:53:19 AM

Document Has Been Signed on 07/19/2022 10:53 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	ROBIN'S NEST, THE		FACILITY NUMBER:	300611895
ADMINISTRATOR:	MARTHA CRAWFORD		FACILITY TYPE:	740
ADDRESS:	2051 S. DELLA LANE		TELEPHONE:	(714) 530-9587
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92802
CAPACITY:	6	CENSUS: 3	DATE:	07/19/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Patricia Luna, Marth Crawford		TIME COMPLETED:	11:05 AM

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	Licensing Program Analyst (LPA) Edward Tapia made an unannounced required annual inspection in this facility. LPA met with staff Patricia Luna and stated the purpose of this visit. Administrator Martha Crawford arrived during the visit at 9:30 AM and provided assistance. The facility is a single level structure and licensed for five non-ambulatory with a hospice waiver for one. This facility is a Residential Care Facility for the Elderly. At about 8:55 AM, LPA Tapia was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. For this visit, LPA observed 3 residents in care and one staff member on duty. LPA toured the interior and exterior portions of the facility. There were 7 resident rooms 4 of which were vacant. Resident rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Manual smoke detectors and carbon monoxide alarms were tested to be operational. LPA noticed that auditory exit alarms were not operational. Administrator was made aware of this and will have them replaced. Bathroom (1) was observed to be in good repair and provided with grab bars and hot water was measured at 106.3 degrees Fahrenheit. LPA noticed that a light bulb needed to be replaced. Bathroom (2) was observed to be in good repair and provided with grab bars and hot water was measured at 107.7 degrees Fahrenheit. Bathroom (3) was observed to be in good repair and provided with grab bars and hot water was measured at 109.5 degrees Fahrenheit. Facility met the minimum two-day supply of perishable and seven-day supply of non-perishable food stock requirements, cleaning supplies and sharp items were inaccessible to residents in care. Facility had adequate supplies of personal protective equipment in place. Fire extinguisher was on observed. For the exterior portion, facility had outside furniture in good repair; and grounds were free of tripping hazards. LPA did notice gardening tools to be out in the open Administrator immediately removed them so residents could not access them. The exterior portion of the facility also contained a swimming pool with a gate surrounding the pool and was locked.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Edward Tapia	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022

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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ROBIN'S NEST, THE	FACILITY NUMBER: 300611895
	VISIT DATE: 07/19/2022

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Garage is kept locked and used for storage and with an emergency washer and dryer. Laundry room is an L sharped room and was in good repair. Kitchen was in good repair with medications kept locked separately. LPA Tapia reviewed the COVID 19 mitigation plan and the Emergency disaster plan of the facility. LPA discussed Assembly Bill 665 that requires a licensee of any adult care residential facility that has internet service to provide at least one internet access device, such as a computer, smart phone, tablet or other device, that: can support real-time interactive applications; is equipped with video conferencing technology, including microphone and camera functions; and is dedicated for client or resident use.

For this visit, no deficiency was noted in areas observed. No citation was issued. Three advisories were issued today.

LPA Tapia conducted an exit interview with Administrator Martha Crawford and copy of this report was explained and left at the facility.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Edward Tapia	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022

LIC809 (FAS) - (06/04)

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