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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003744
Report Date: 03/02/2023
Date Signed: 03/02/2023 03:59:43 PM

Document Has Been Signed on 03/02/2023 03:59 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: 64DATE:
03/02/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:31 PM
MET WITH:Marjan Arastoo, Licensee/Administrator and Assistant AdministratorTIME COMPLETED:
04:07 PM
NARRATIVE
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 On today's date, Licensing Program Analyst (LPA) Rosie Quiroz and (LPA) Celine Deperio conducted a Case Management- Deficiencies visit in conjunction with the ten day Complaint inspection visit #22-AS-20230221084412. LPAs arrived to the facility and were greeted by Assistant Administrator Brian Mahinay and met with Licensee/Administrator (L/AD) Marjan Arastoo and discussed purpose of today's visit.

During the course of the investigation of Complaint Control #22-AS-20230221084412, while conducting interviews with interviewees consisting of staff and residents, and while touring the interior and exterior of the facility along with (L/AD) Marjan Arastoo the following deficiencies were observed: California Code of Regulations Reporting Requirements 80061(b)(1)(A), Personnel Requirements -85965(b)(c)
and Health Related Services (k)(1). Facility is being cited during today's date visit. (SEE LIC 809-D pages)

Today's report was reviewed with (L/AD) Marjan Arastoo and a copy of this report, LIC 809-D pages and Appeal Rights were provided at exit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE: DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2023
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 03/02/2023 03:59 PM - It Cannot Be Edited


Created By: Rosie Quiroz On 03/02/2023 at 01:41 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: 03/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/02/2023
Section Cited
CCR
80061(b)(1)(A)

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80061(b)(1)(A):Reporting Requirements (b) Upon the occurrence, during the operation of the facility, of any of the events specified...a report shall be made to the licensing agency within the agency's next working day during its normal business hours. In addition, a written report containing the CONTINUED...
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(L/AD) Arastoo agreed to read CCR 85965(b)(c) and submit proof of understanding by POC due date of 3/6/2023.
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CONT... information specified in (2) below shall be submitted to the licensing agency within seven days following the occurrence of such event.(1)Events reported shall include the following: (A) Death of any client from any cause. This requirement is not met as evidenced by, upon record review of CONT...
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death reports and incident reports discussed during today's visit, LPAs did not locate death reports and incident reports between December 2, 2022-February 13, 2023. This was verified with L/AD Arastoo. This poses an immediate risk to clients in care.
Type B
03/02/2023
Section Cited
CCR85965(b)(c)

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Personnel Requirements-85965(b)(c)
(b) The licensee shall employ staff as necessary to ensure provision of care and supervision to meet client needs.
(c) The licensee shall employ support staff as necessary to perform office work...This requirement was not met as evidenced by
CONTINUE
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(L/AD)Arastoo agreed to read CCR 85965(b)(c) and submit proof understanding by POC due date of 3/6/2023, and submit schedule reflecting caregiving coverage so AD can focus on Administrator duties.
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While conducting interviews for complaint control#22-AS-20230221084412, interviewees indicated there was 1 caregiver working. L/AD indicated also working as a caregiver indicating not having time to complete special incident reports for all incidents CONTINUED
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CONT...requiring reporting requirements. This was verified with (L/AD) Arastoo. This poses a potential risk to clients in care.
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 Ortiz
LICENSING EVALUATOR NAME:Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/02/2023 03:59 PM - It Cannot Be Edited


Created By: Rosie Quiroz On 03/02/2023 at 02:40 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: 03/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/02/2023
Section Cited
CCR
80075(k)(1)

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Health Related Services 80075(k)(1):(k)The following requirements shall apply to medications which are centrally stored:
(1) Medication 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.CONTINUE...
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L/AD Arastoo will read and understand CCR80075, repair medication room entrance door so it's not accessible to clients in care and submit proof of medication training to medication technicians by POC due date of 3/3/2023.
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This requirement is not met as evidenced by: During today's visit, while LPAs conducted tour of facility and were conducting interviews, LPAs observed medication cart unlocked at 9:45 and 11:52am and medication stored on top of medication cart readily CONTINUED...
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available for clients in care. LPAs obseved half door entrance in medication room with no window creating readily available access to medication room. This was verified with L/AD Arastoo. This poses an immediate risk to clients 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 Ortiz
LICENSING EVALUATOR NAME:Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:
DATE: 03/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/02/2023


LIC809 (FAS) - (06/04)
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