<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003744
Report Date: 09/14/2021
Date Signed: 09/14/2021 01:45:36 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/14/2021 01:45 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:QUALITY CARE PLUSFACILITY NUMBER:
306003744
ADMINISTRATOR:MARJAN ARASTOOFACILITY TYPE:
735
ADDRESS:1652 W. BROADWAYTELEPHONE:
(714) 635-6561
CITY:ANAHEIMSTATE: CAZIP CODE:
92802
CAPACITY: 80CENSUS: 74DATE:
09/14/2021
TYPE OF VISIT:Case Management - Annual ContinuationANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Marjan ArastooTIME COMPLETED:
01:45 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
This announced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering the report for an Annual Inspection conducted on 9/3/21 and conducting a Technical Assistance inspection via tele-visit due to COVID-19 and for precautionary measures. LPA Haddad met with Administrator (AD) Marjan Arastoo and discussed the purpose of the inspection. LPA Haddad paused the inspection 12:00 PM and resumed the inspection at 1:00 PM.

During the inspection on 9/3/21, Licensing Program Manager (LPM) Marina Stanic and LPAs Lydia Martinez, Norman Woodridge, and Sean Haddad, AD, and facility staff Abdul Arastoo conducted a tour of the inside and outside of the facility, common areas, resident rooms, and kitchen and observed the following:

During the inspection, LPAs and AD observed there were 5 staff present. LPAs observed 74 residents were present. LPAs confirmed the residents were doing well. LPAs inspected common areas, resident rooms, and kitchen. LPAs observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. LPAs observed hallways and walkways were free of obstruction.

During the inspection on 9/3/21, LPAs observed multiple public bathrooms lacking soap, paper towels, and toilet paper. During today’s inspection, LPA Haddad and AD observed the public bathroom on the first floor lacking soap and toilet paper.

LPA Haddad reviewed and confirmed facility policies and practices regarding resident screening, staff screening, visitation, COVID-19 surveillance testing, COVID-19 clearance testing, quarantine, isolation, cohorting, staffing, infection control/lead/training, PPE, staffing and staffing shortages, and communication and emergency plan.
SUPERVISORS NAME: Marina Stanic
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2021
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 3
Document Has Been Signed on 09/14/2021 01:45 PM - It Cannot Be Edited


Created By: Sean Haddad On 09/14/2021 at 01:13 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: QUALITY CARE PLUS
FACILITY NUMBER: 306003744

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/21/2021
Section Cited
CCR
80072(a)(2)

1
2
3
4
5
6
7
80072 Personal Rights: (a) … each client shall have personal rights which include … (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee states they will immediately stock the public bathrooms with soap, paper towels, and toilet paper and submit proof to LPA by POC due date.
8
9
10
11
12
13
14
Based on observation, while the clients have their own personal bathrooms, the licensee did not ensure the 3 public bathrooms were stocked with soap, paper towels, and toilet paper, which poses a potential health and safety risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Marina Stanic
LICENSING EVALUATOR NAME:Sean Haddad
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2021


LIC809 (FAS) - (06/04)
Page: 2 of 3
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: QUALITY CARE PLUS
FACILITY NUMBER: 306003744
VISIT DATE: 09/14/2021
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
26
27
28
29
30
31
32
LPA Haddad provided technical assistance regarding temperature logs, visitation, outings, COVID-19 postings, and N95 fit testing. LPA Haddad requested and reviewed resident roster, staff roster, and COVID-19 mitigation plan.

Based on the observations made during today’s inspection and the inspection on 9/3/21, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted with Facility representative via tele-visit. This report and appeal rights will be emailed and an electronic email read receipt confirms receipt of the report. Facility representative agrees to send a signed copy by email.
SUPERVISORS NAME: Marina Stanic
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
LIC809 (FAS) - (06/04)
Page: 3 of 3