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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005287
Report Date: 05/31/2022
Date Signed: 05/31/2022 03:48:05 PM


Document Has Been Signed on 05/31/2022 03:48 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:AMERIHEART CARE HOMEFACILITY NUMBER:
306005287
ADMINISTRATOR:YCASAS, TIMOTHYFACILITY TYPE:
740
ADDRESS:9622 KATELLA AVENUETELEPHONE:
(714) 733-8095
CITY:ANAHEIMSTATE: CAZIP CODE:
92804
CAPACITY:6CENSUS: 4DATE:
05/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Rowena DialegTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Lydia Martinez made an unannounced visit to the facility for the purpose of conducting a Required - 1 Year Annual inspection, with an emphasis on Infection Control. LPA Martinez was screened upon entry into the facility. LPA met with Caregiver Rowena Dialeg and explained the reason for the visit. Staff Dialeg confirmed there are currently no cases or exposures of COVID-19 within the facility. Administrator Timothy Ycasas arrived shortly after. LPA toured the facility with Staff Dialeg. Facility has 4 residents in care during today's visit with none receiving Hospice care. LPA observed residents relaxing in the facility. All residents appeared happy and well taken care of. Facility appears clean and sanitary. All resident rooms had the required elements as well as restrooms stocked with soap, sanitizer, and paper towels as well as hand washing signs. Four rooms are single occupancy and one is double occupancy. Facility screens all visitors to the facility and LPA observed the screening/sanitizing station in the facility. Facility utilizes a visitor screening sheet. Facility screens residents and staff temperatures and documents results. LPA observed ample sanitizer spread out throughout the facility. Facility has COVID precaution postings as well as all required Department postings. Facility Mitigation Plan has been approved. LPA observed the emergency disaster plan posted in facility. LPA observed an ample supply of emergency food and water stored in the garage. Smoke detectors tested operational during today's visit as well as Fire Extinguishers are fully charged. LPA toured the outside grounds and observed a shaded outside visitation area. LPA observed a locked closet where medication is stored. Facility has ample supply of PPE and cleaning supplies. Facility has a plan for COVID testing residents and staff as needed as well as a plan for isolation and quarantine. LPA reviewed resident files during the visit and all files are up to date. All residents and staff are vaccinated for COVID-19. LPA consulted with Staff on the importance of documenting temperature. LPA reviewed and confirmed facility policies and practices regarding resident screening, staff screening, visitation, COVID-19 surveillance testing, COVID-19 clearance testing, quarantine, isolation, cohorting, infection control training, PPE, staffing and staffing shortages. No deficiencies noted during today's visit. An exit interview was conducted and a copy of this report was emailed during today's visit.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Lydia MartinezTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2022
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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