331880986-2-10-2022-18-AS-CCON-CBHU4W-20220210141550

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331880986
Report Date: 02/10/2022
Date Signed: 02/10/2022 02:16:04 PM

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:	HONORS WAY CARE HOME		FACILITY NUMBER:	331880986
ADMINISTRATOR:	VALDEZ, DIANA D		FACILITY TYPE:	740
ADDRESS:	26818 HONORS WAY		TELEPHONE:	(562) 338-5574
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92555
CAPACITY:	6	CENSUS: 2	DATE:	02/10/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Diana Valdez - Administrator		TIME COMPLETED:	02:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of completing the facility's Annual Inspection. LPA Colvin met with Administrator Diana Valdez and advised of the purpose of the visit, and that the Annual Inspection will be limited to Infection Control only. Below is a summary of what was observed: Infection Control: LPA Colvin went over COVID-19 best practices for infection control and prevention with Administrator Diana Valdez, who LPA Colvin found to be successfully incorporating the several aspects of the facility's Mitigation Plan. Residents have hand sanitizer available to them, and the bathrooms were stocked with hand soap. LPA Colvin observed the facility's bathrooms and noted that they did not have any paper towels. LPA Colvin did observe a common hand towel in the bathroom used by visitors. LPA Colvin advised the facility to utilize paper towels in all bathrooms to prevent the potential spread of bacteria and viruses. LPA Colvin will be issuing a Technical Assistance Advisory Note instead of a deficiency due to the bathroom used by the current residents (master) having a cloth towel used by one resident only, as the other resident has staff assistance with hand washing. Administrator Diana confirmed that visitors are being screened prior to entry into the facility, and that the facility is utilizing a sign-in log which documents the responses from the visitors. Administrator Diana inquired about additional recommended screening procedures, and LPA Colvin informed her of the recent visitation guidance from the Department of Public Health (CDPH), which outlines that visitors must show proof of vaccination and booster, as well as negative COVID-19 test in the last 48 hours to visit indoors, or if unvaccinated or incompletely vaccinated, visitors can visit outside with proof of a negative COVID-19 test in the last 48 hours. LPA Colvin inquired as to if staff have been fit tested for N95 masks, and Administrator Diana Valdez confirmed that they have conducted fit testing for staff. LPA Colvin confirmed through observation that all staff present were wearing face coverings during LPA Colvin's inspection.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022

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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: HONORS WAY CARE HOME	FACILITY NUMBER: 331880986
	VISIT DATE: 02/10/2022

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LPA Colvin also inquired about if the facility is still screening their residents daily for COVID-19 symptoms, which includes checking their temperature, which Administrator Diana Valdez confirmed that the facility is continuing to do. LPA Colvin requested to inspect the facility's Personal Protective Equipment (PPE) supply, which is stored in a closet. LPA Colvin observed the facility to have a 30-day supply of gloves, N95 masks, surgical masks, isolation gowns, and sanitizer, but did not observe any face shields or eye goggles. Administrator Diana looked for face shields in the supplies, but was unable to locate any. LPA Colvin will be issuing a Technical Assistance Advisory Note instead of a deficiency due it being difficult to access face shields at numerous points during the COVID-19 pandemic. LPA Colvin advised the facility to purchase face shields for a complete 30-day supply of PPE for the facility.

An exit interview was conducted with Administrator Diana Valdez and a copy of this report and LIC9102 TA Advisory Notes was provided.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 02/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022

LIC809 (FAS) - (06/04)

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