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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880975
Report Date: 03/11/2022
Date Signed: 03/11/2022 02:36:04 PM


Document Has Been Signed on 03/11/2022 02:36 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:OHANA HOMECARE, INC.FACILITY NUMBER:
331880975
ADMINISTRATOR:FATIMA LINTAG BROWNFACILITY TYPE:
740
ADDRESS:69814 FATIMA WAYTELEPHONE:
(760) 832-7931
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY:6CENSUS: 4DATE:
03/11/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Administrator Fatima Lintima BrownTIME COMPLETED:
02:45 PM
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Licensing Program Analysts(LPA's) Crystal Colvin and Venus Mixson made an unannounced visit to the facility to conduct an annual inspection focused on infection control. LPA's were greeted and granted entry by, Administrator Fatima Lingtag Brown and LPA's explained the purpose of the visit.

The facility currently has zero positive or suspected Covid-19 cases. LPA's toured the facility and observed the following regarding the infection control measures that the facility has implemented. LPAs observed Covid-19 postings posted throughout the facility. The facility has an adequate amount of hand hygiene supplies (soap, hand sanitizer) in all restrooms. All restrooms had trash bins with tight fitting lids. Facility has a 30 day supply of PPE.

The facility has a plan in place to monitor residents regularly for any changes in condition, which includes daily temperature checks. The Facility will contact the resident's physician should there be event of any COVID-19 related illnesses. The facility also has a designated infection control lead and cleans and disinfects the highly touched surfaces during each shift, and as needed.


Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and a copy of this report was provided to administrator Fatima Lingtag Brown .

SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0231
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:
DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/11/2022
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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