306005166-8-16-2022-22-AS-JCHO-CHCVH2-20220816162624

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005166
Report Date: 08/16/2022
Date Signed: 08/16/2022 04:26:38 PM

Document Has Been Signed on 08/16/2022 04:26 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:	DELIGHTFUL LIVING TOO		FACILITY NUMBER:	306005166
ADMINISTRATOR:	BUBOI, REBEKAH		FACILITY TYPE:	740
ADDRESS:	24971 CAMBERWELL STREET		TELEPHONE:	(714) 600-5845
CITY:	LAGUNA HILLS	STATE: CA	ZIP CODE:	92653
CAPACITY:	6	CENSUS: 6	DATE:	08/16/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:51 PM
MET WITH:	Rebekah Buboi		TIME COMPLETED:	04:45 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	On 08/16/2022, Licensing Program Analyst (LPA) Jessica Cho conducted an unannounced visit to Delightful Living Too. The purpose of today's visit was to conduct a Required 1 Year visit focusing primarily on the Infection Control. At 12:58pm, LPA Cho was allowed entry into the facility and met with Licensee/Administrator (Admin) Rebekah Buboi after completing the Coronavirus 2019 (COVID-19) screening procedure. Caregiver Viorel Buboi was also present at this time. As of today, there are no active COVID-19 cases in the facility. Facility screens and documents temperatures for visitors on a sign in sheet. LPA observed the required COVID-19 precautionary signs posted on the front door and throughout the facility. The Complaint Poster (PUB475) was observed in the size of 8.5"x14" on the bulletin board. Admin was informed to obtain the poster in the required sizing of 20"x26." The facility is licensed for six non-ambulatory residents and has a hospice waiver for three. There are currently six residents living in the facility of which two are receiving hospice care. The Administrator's Certificate for Rebekah Buboi expires on 09/26/2023. At 1:16pm, LPA observed the Video Surveillance Camera and Rights of Resident Councils regulations posted on the bulletin board. LPA inquired if the facility is utilizing surveillance cameras and Admin confirmed that two cameras are present in two resident rooms and are not being used at this time but are used as needed. LPA discussed the guidelines for the use of video surveillance system in the facility. Per Admin, the families of all six residents have consented to the use of surveillance cameras in the private bedrooms and have also signed a Resident Safety and Monitors Including Video Cameras consent form. At 2:01pm after the conference call with LPM Sheila Santos, LPA Cho and Admin Rebekah conducted a tour of the physical plant. The single story home consists of six resident bedrooms with four resident bathrooms. Admin Rebekah and Caregiver Viorel Buboi reside at the facility and occupy one staff bedroom and staff bathroom. The facility also has a living room, family room, dining area, kitchen, laundry room, and an attached three car garage. LPA inspected five out of the six resident bedrooms.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022

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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Document Has Been Signed on 08/16/2022 04:26 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: DELIGHTFUL LIVING TOO	FACILITY NUMBER: 306005166
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/16/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87303(e)(2)

87303(e)(2) Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, hot water measured above 120 degrees Fahrenheit in three out of the four resident bathrooms which poses a potential Health, Safety, and Personal Rights risk to persons in care.
	POC Due Date: 08/27/2022
	Plan of Correction
1 2 3 4	Licensee agrees to readjust the water temperature and submit a 7 day log effective 08/20/2022 and ending on 08/27/2022. Licensee to submit the proof of correction to LPA via email by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022

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: DELIGHTFUL LIVING TOO	FACILITY NUMBER: 306005166
	VISIT DATE: 08/16/2022

NARRATIVE

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LPA did not inspect Resident #1's (R1's) bedroom and private bathroom per the resident's request. The five out of the six resident bedrooms had the required furnishings, 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, showers were free of mold/mildew, and a non-skid mat was in place. Resident bath towels and personal hygiene supplies were adequately stocked including paper towels and hand soaps. LPA observed the hand washing signs. LPA Cho tested the hot water temperature in three out of the four resident bathrooms and the temperatures measured at 143.6 degrees Fahrenheit in the Bathroom #1, 144.8 degrees Fahrenheit in Bathroom #2, and 145.0 degrees Fahrenheit in Bathrooms #3.

LPA Cho inspected the kitchen along with Admin Rebekah. Perishable and non-perishable food supplies were checked and adequately stocked at the time of the visit. The fire extinguisher was fully charged. The smoke and carbon monoxide detectors were tested and operational. Medications, toxins, and sharps were locked and inaccessible to the residents. The auditory alarms throughout the facility were in operating condition.

LPA Cho toured the outside grounds along with Admin Rebekah. There were no bodies of water present. There was shading and sufficient seating for residents. Walkways around the home were clear of hazards, and the exit gates were self-closing and self-latching. There were no security bars or weapons on the premises.

LPA Cho reviewed the Emergency and Disaster Plan for Residential Care Facilities for the Elderly (LIC610E). Facility does have back-up emergency food and water supply. The First Aid Kit met all the required components except the first aid manual, and the facility had sufficient PPEs and antigen testing kits.

No resident or staff files were reviewed at the time of this visit. LPA reviewed the COVID-19 mitigation plan of the facility as well as Assembly Bill (AB)665. This bill would require residential facilities serving adults, residential care facilities for persons with chronic life-threatening illness, and residential care facilities for the elderly with existing internet service to provide at least one internet access device that can support real-time interactive applications, is equipped with video conferencing technology, and is dedicated for client or resident use.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022

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: DELIGHTFUL LIVING TOO	FACILITY NUMBER: 306005166
	VISIT DATE: 08/16/2022

NARRATIVE

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The facility does have an existing internet service and provides a smart phone upon the resident's request. In addition, LPA discussed the importance of staying in compliance with the latest guidelines which includes the Infection Control Plan (LIC9282).

LPA provided the following guidance to Administrator Buboi: to not have cameras in the residents' bedrooms as it violates their personal rights, enlarge the Complaint Poster (PUB475) to the required sizing of 20"x26," to obtain the current edition of the first aid manual, to submit the Infection Control Plan (LIC9282) by August 31, 2022, and to staying abreast with CCLD's COVID-19 guidance by reviewing and printing the Provider Information Notices (PINs) as well as by attending the CCLD Informational Calls. The PINs can be accessed at: www.ccld.ca.gov.

Based on the observations made during today's visit, a deficiency is cited in this review as per Title 22 Division 6 of the California Code of Regulations. Advisory Notes (LIC9102) were issued during the visit. An exit interview was conducted with Licensee/Administrator Rebekah Buboi, and a copy of this report (LIC809, LIC809C, LIC809D, LIC9102s, along with the appeal rights) were provided.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2064
LICENSING EVALUATOR NAME: Jessica Cho	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022

LIC809 (FAS) - (06/04)

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