306006011-6-7-2022-22-AS-RQUZ-CF6P2X-20220607105640

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306006011
Report Date: 06/07/2022
Date Signed: 06/07/2022 10:56:44 AM

COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/07/2022 10:56 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:	VIRTUD CARE LLC		FACILITY NUMBER:	306006011
ADMINISTRATOR:	SANCHEZ, GEISEL DAGNE		FACILITY TYPE:	740
ADDRESS:	13092 NEWLAND ST		TELEPHONE:	(714) 583-8441
CITY:	GARDEN GROVE	STATE: CA	ZIP CODE:	92844
CAPACITY:	6	CENSUS: 4	DATE:	06/07/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Geisel Sanchez, Licensee/Administrator		TIME COMPLETED:	10:55 AM

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On today's date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA Quiroz was greeted, COVID-19 screened and granted entry into the facility by Caregiver (CG) Nancy Villanueva. LPA Rosie Quiroz explained the nature of the visit. Licensee/Administrator (L/AD) Geisel Sanchez arrived shortly after. Facility indicated screening all incoming visitors prior to entering the facility. Facility is licensed to provide services to Age range 60 and over, Fire Clearance for (5) five Non Ambulatory residents, and (1) one bedridden in Room #1 and has a Hospice Waiver for (6) six residents. Facility currently providing services to (3) three residents on hospice. Administrator Geisel Sanchez has a current Administrator certificate with expiration date of February 12, 2022. AD Sanchez indicated she completed Administrator course on December 21, 2021 and still waiting for new Administrator certificate to be processed and mailed out.

On or about 9:32am, LPA Rosie Quiroz along with (L/AD) Geisel Sanchez began the tour of the inside and outside of the facility. There are four (4) residents in care and there are no active COVID-19 cases in the facility. LPA Quiroz observed one of four residents in their bedroom resting, and three of four residents observed to be resting and watching television in living-room area supervised by caregivers. LPA Quiroz interacted and interviewed with resident's during today's visit. Four of four residents appeared to be clean and well taken care of. LPA Quiroz observed a COVID-19 check in station in the entry of the facility; LPA Quiroz observed required department COVID-19 precautionary postings in the facility as well as hand washing signs throughout the facility. Facility temperature recorded to be 75 degrees Fahrenheit.

All restrooms observed to have a supply of soap, appeared to be clean and water temperatures were recorded to be within 113 degrees Fahrenheit. LPA Quiroz inspected resident’s bedrooms and appeared to be clean. All bedrooms observed to have all required components. LPA Quiroz observed the emergency and disaster and evacuation plan.

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SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

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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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: VIRTUD CARE LLC	FACILITY NUMBER: 306006011
	VISIT DATE: 06/07/2022

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Facility has a supply of emergency food, water and PPE in garage area readily available for staff and residents. LPA Quiroz toured the outside of the facility and observed seating and shaded area for residents and visitor's enjoyment in backyard area.

The facility has completed the LIC 808 Mitigation Plan. The LIC 808 plan was received by the Department on July 13, 2021. During today's visit, LPA Quiroz reviewed and approved LIC 808 Mitigation Plan dated July 13, 2021. LPA Quiroz was informed that all residents have had their COVID-19 vaccinations, and staff have had their COVID vaccinations and first booster. The Facility indicated to be recording resident's temperatures daily.

Based on the observation made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations. LIC 9102 Advisory Note-Technical Assistance observed during today's visit. (SEE LIC 9102 TA)

During today's visit, LPA Quiroz provided Consultation on Title 22 and COVID-19 Infection control throughout today's visit.

This report was reviewed with (L/AD) Geisel Sanchez, and a copy of this report, LIC 9102 TA and LIC 811 Confidential Names were provided at exit.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

LIC809 (FAS) - (06/04)

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