306004498-8-28-2024-22-AS-MTEA-D8KPNN-20240828112813

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306004498
Report Date: 08/28/2024
Date Signed: 08/28/2024 11:28:45 AM

Document Has Been Signed on 08/28/2024 11:28 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	CLOSE TO HOME SENIOR CARE		FACILITY NUMBER:	306004498
ADMINISTRATOR:	MARICAR PARNELL		FACILITY TYPE:	740
ADDRESS:	703 GROVE AVENUE, E.		TELEPHONE:	(714) 707-5027
CITY:	ORANGE	STATE: CA	ZIP CODE:	92865
CAPACITY:	6	CENSUS: 4	DATE:	08/28/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Maricar Parnell		TIME COMPLETED:	11:42 AM

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Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. At around 8:00 AM, LPA Tea was greeted and granted entry into the facility by caregiver, Sony Salinas and explained the reason for the visit. The administrator (AD) Maricar Parnell arrived shortly to assist with the visit. The facility is licensed for 6 non-ambulatory residents with a hospice waiver for four. Currently there are four residents, of which two are on hospice during today's visit.

Around 8:15 AM, LPA Tea reviewed four resident files and two staff files. Resident files and staff files contained all required documentation. Upon review of records, the facility is up to date with required quarterly fire drill, which was last conducted in June 26, 2024. AD Parnell administrator certificate is currently expired however administrator has complied with all course work and is pending renewal at this time.

LPA Tea along with AD Parnell toured the facility at 9:19 AM. LPA toured the physical plant, checked food service, and the first aid kit. The facility is a single-story home that consists of 5 resident bedrooms, 1 staff room, 2 bathrooms, living room, dining room, kitchen and attached garage. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, and showers were free of mold/mildew. Water temperature measured around 112.1 F degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including bandages, tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit.

LPA observed sharps locked and inaccessible to residents underneath the kitchen sink. LPA also observed toxin substances secured underneath the kitchen sink and secured in the laundry area. The fire extinguishers are fully charged in the facility. Kitchen appliances are operational during today's visit.

Annual continuation on LIC809-C

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Michael Tea	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

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

FACILITY NAME: CLOSE TO HOME SENIOR CARE	FACILITY NUMBER: 306004498
	VISIT DATE: 08/28/2024

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LPA toured the outside grounds and there is ample seating underneath a shaded patio area in the backyard. There are a lot of fruits and vegetables plants and trees in the backyard. There are two exit gates that are self-latching and operational on both sides of the house. LPA observed PPE supplies, emergency food and water stored in the garage. Facility provides activities based on their personal choice. Residents walk around the backyard and do some gardening in the yard. At the time of the visit, LPA observed residents having breakfast and lounging in the living room watching television and doing some wheelchair exercises.

At 9:53 AM LPA reviewed medication storage and administration. Medications are stored in a locked cabinet in the dining area. Medications are being administered per physician order. LPA interviewed residents regarding their quality of care and spoke to staff present regarding care provided.

Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with Administrator Maricar Parnell and a copy of this report LIC809, along with the 809-C, LIC858, and LIC859 were read and provided to the facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Michael Tea	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

LIC809 (FAS) - (06/04)

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