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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005836
Report Date: 10/20/2022
Date Signed: 10/20/2022 11:30:34 AM


Document Has Been Signed on 10/20/2022 11:30 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:CASA DOLCE HOMEFACILITY NUMBER:
306005836
ADMINISTRATOR:EMIGH, JEANINEFACILITY TYPE:
740
ADDRESS:1601 SKYLINE DRIVETELEPHONE:
(714) 213-8423
CITY:FULLERTONSTATE: CAZIP CODE:
92831
CAPACITY:6CENSUS: 4DATE:
10/20/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Jeanine EmighTIME COMPLETED:
11:45 AM
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of a health and safety check. LPA met with Administrator (AD) Jeanine Emigh and explained the purpose of the inspection.
During the inspection, LPA and AD toured the facility. LPA conducted health and safety checks on the 4 residents and confirmed they were doing well and LPA observed no health and safety issues. LPA observed the facility to be clean and organized, and found no health and safety issues. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. LPA observed 2 staff present wearing PPE.
LPA interviewed AD who provided an update on the gaps in staff coverage discussed during LPA’s 10/19/22 inspection. AD stated that the staff who had called out had returned, that AD had secured temporary staff from an agency to cover other gaps, and that AD is working to hire additional permanent staff and secure additional temporary staff from the agency. AD also stated that because there are fewer gaps in staff coverage and AD’s health is improving, AD is able to cover any gaps in staff coverage for the next 7 days.
LPA discussed the long-term plan for staffing with AD as well as possible next steps for the facility. AD stated that the staffing situation will be stable for the next month because certain staff had returned, AD obtained temporary staff from an agency, AD is working to hire additional permanent staff and secure additional temporary staff from the agency, and AD is able to cover any gaps in staff coverage.
AD agreed to provide LPA daily updates on the staffing situation and to engage in a discussion with the Orange County Regional Office regarding the next steps for the facility. LPA provided AD a list of additional staffing agencies and encouraged AD to reach out to more than 1 agency. LPA and AD discussed additional resources including the RCFE Association, the Long-Term Care Ombudsman, and local licensees, facilities, and staff.
Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:
DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/20/2022
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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