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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005196
Report Date: 02/14/2024
Date Signed: 02/14/2024 02:11:11 PM

Document Has Been Signed on 02/14/2024 02:11 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:CASA DEL SOLFACILITY NUMBER:
306005196
ADMINISTRATOR:MENDOZA, IRVINFACILITY TYPE:
740
ADDRESS:6486 EAST CALLE DEL NORTETELEPHONE:
(714) 602-8234
CITY:ANAHEIM HILLSSTATE: CAZIP CODE:
92807
CAPACITY: 6CENSUS: 3DATE:
02/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Irvin Mendoza, AdministratorTIME COMPLETED:
02:25 PM
NARRATIVE
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit for the purpose of conducting a Required Annual Inspection. LPA was greeted and granted entry by caregiving staff after introducing himself and stating the purpose of the visit. Administrator Irvin Mendoza was contacted by phone and arrived later to assist with the visit.

During the inspection, LPA and administrator conducted a tour of the physical plant and observed the following: The facility is a one-story home with six resident bedrooms, one staff room, three bathrooms, and attached two-car garage. All resident bedrooms had the required furnishings. LPA observed all beds had linens and blankets and an adequate supply of linen is present in the hallway closet. The backyard has a shaded sitting area and the route of egress is free of clutter and obstructions. There are currently three residents in care at the facility. Bathrooms faucets and toilets were operational. Water temperature tested between 114F and 118F degrees. LPA observed emergency disaster plan with means of exiting and emergency phone numbers listed and posted. Food menu was also posted and visible. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguishers were observed to be fully charged with up-to-date maintenance. Sharps were observed locked in a drawer in the kitchen.LPA observed cleaning supplies to be stored in a locked cabinet under the kitchen sink, however some cleaning products such as bleach and Clorox were found in unlocked cabinets in other bathrooms. Additionally the staff room is observed to not be locked and a laundry unit in the backyard does not lock either. The medication central storage was observed to be locked. LPA reviewed three resident files and five staff files and interviewed staff and residents present.

Based on the observations made during today’s inspection, three deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations along with two Advisory Notes issued. An exit interview was conducted, and a copy of this report along with appeal rights was left at the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2024
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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Document Has Been Signed on 02/14/2024 02:11 PM - It Cannot Be Edited


Created By: Kevin Saborit-Guasch On 02/14/2024 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: CASA DEL SOL
FACILITY NUMBER: 306005196

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87705(f)(2)
Care of Persons with Dementia
(f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation conducted during a tour of the physical, the licensee did not comply with the section cited above. Clorox and bleach were observed to be stored in two unlocked bathroom cabinets. The staff room contains medication and supplement and is unlocked. The laundry room sliding door is not equipped with a lock from the outside. These pose an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/15/2024
Plan of Correction
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Cleaning supplies were removed and placed in the locked kitchen cabinet. Staff room was locked during the visit and licensee will provide LPA with a plan to secure the laundry area. Citation cleared during the initial visit.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Sheila Santos
LICENSING EVALUATOR NAME:Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2024


LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 02/14/2024 02:11 PM - It Cannot Be Edited


Created By: Kevin Saborit-Guasch On 02/14/2024 at 01:42 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: CASA DEL SOL
FACILITY NUMBER: 306005196

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.625(b)(2)
Other Provisions
(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on a review of staff files mantained at the facility, the licensee did not comply with the section cited above as one recent hire had not undergone initial training after over a month of association to the facility.This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/14/2024
Plan of Correction
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The licensee will ensure new hires receive initial training timely and provide proof of completion to LPA before the plan of corrections due date.
Type B
Section Cited
CCR
87608(a)(5)(B)
Postural Supports
(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation conducted during the tour of the physical plant, the licensee did not comply with the section cited above. One resident was observed to be in a bed with full-length rails even though they had not been admitted to hospice.This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/14/2024
Plan of Correction
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Due to the identified fall risk, licensee will request a physician order for half rails for the resident in question. Full rails removed during the visit. Deficiency cleared.
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
LICENSING EVALUATOR NAME:Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2024


LIC809 (FAS) - (06/04)
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