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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306002309
Report Date: 08/24/2022
Date Signed: 08/24/2022 12:38:18 PM


Document Has Been Signed on 08/24/2022 12:38 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:EUROPEAN LOVING CARE IFACILITY NUMBER:
306002309
ADMINISTRATOR:COTILIA DAHABREHFACILITY TYPE:
740
ADDRESS:6561 DOHRN CIRCLETELEPHONE:
(714) 848-5544
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY:6CENSUS: 6DATE:
08/24/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Administrator, Cotilia DahabrehTIME COMPLETED:
01:00 PM
NARRATIVE
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On this day Licensing Program Analyst (LPA) Jenifer Tirre made an unannounced case management visit in conjunction with complaint visit 22-AS-202201819120252. LPA were granted entry by staff. LPA identified themselves and discussed purpose of the visit with Administrator Cotilia Dahabreh.

During visit LPA observed inside the kitchen a unlocked cabinet door under the sink which contained hazardous toxins such as awesome cleaning spray and Clorox spray. LPA observed unsecured knives inside open kitchen drawer. Facility has six residents with with a diagnosis of Alzheimer's Dementia. Two residents are ambulatory. LPA observed an unsecured kitchen cabinet containing prepped medication inside labeled pill containers for the day as well as several bottles of liquid medications.


Based on the observations made during today's visit, the following violations are being cited per California Code of Regulations Title 22.

An exit interview was conducted and a copy of this report along with appeal rights were left at the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2022
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


Document Has Been Signed on 08/24/2022 12:38 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868


FACILITY NAME: EUROPEAN LOVING CARE I
FACILITY NUMBER: 306002309

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/25/2022
Section Cited

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The following shall be stored inaccessible to residents with dementia: Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not being met as evidenced by:
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Based on observation, Licensee failed to ensure Knives and cleaning sprays were inaccesible to residents with Dementia. All 6 residents have a diagnosis of Dementia.This poses an immediate health and safety risk to residents in care.
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Type A
08/25/2022
Section Cited

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Incidental Medical and Dental services. Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not being met as evidenced by:
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Based off observations Licensee failed to ensure medications are inaccessible to persons other than employees. This poses an immediate health and safety risk to residents in care.
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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: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2