331881115-5-18-2022-18-AS-JARA-CEJUUQ-20220518155354

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331881115
Report Date: 05/18/2022
Date Signed: 05/18/2022 03:54:03 PM

Document Has Been Signed on 05/18/2022 03:54 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:	ANGEL'S LOVING TOUCH		FACILITY NUMBER:	331881115
ADMINISTRATOR:	CERDA, YAZMIN S.		FACILITY TYPE:	740
ADDRESS:	37212 EDGEMONT DRIVE		TELEPHONE:	(951) 249-9041
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92563
CAPACITY:	6	CENSUS: 6	DATE:	05/18/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Administrator- Yazmine Cerda		TIME COMPLETED:	04:00 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), Janira Arreola made an unannounced visit to the facility to conduct an annual inspection focused on infection control. LPA was granted entry and met with Administrator Yazmine Cerda, who was informed of the purpose of the visit. At the time of visit there was 3 staff and 6 residents present. The facility currently has zero positive or suspected Covid-19 cases. During today's visit, LPA toured the facility and made observations regarding the infection control measures that the facility has implemented. LPA observed Covid-19 postings and a single entry point was designated where symptoms screenings and temperature checks occur daily for all visitors, residents, and staff. The facility had a plan in place through a online database system to track resident records which was shown to LPA by the facility Technical Support individual (TV). The facility had an adequate amount of hand hygiene supplies (soap, hand sanitizer, paper towels) in all restrooms. Common areas such as dining rooms and living rooms have been modified with social distancing and masking policies. There are designated isolation rooms and a plan in place to monitor and attend to those in the isolation rooms. LPA observed a sufficient 30-day supply of PPE equipment. The facility also has a designated infection control lead and a plan in place to clean and disinfect the highly touched surfaces. LPA advised Administrator to provide the department with a copy of the facility Mitigation plan that was previously submitted to the department.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira Arreola	TELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

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: ANGEL'S LOVING TOUCH	FACILITY NUMBER: 331881115
	VISIT DATE: 05/18/2022

NARRATIVE

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During the visit LPA was informed about a new Hospice admittance for R1 on 5/13/2022 and was able to provide a signed hospice admittance letter to LPA.

LPA also requested an LIC500 and noticed S1 and S2 where not associated to the current facility # 331881115 but they were associated to the previous facility that went under a change in ownership called “Sacred Heart”. LPA will assure that all staff where transfered to the new facility number and that facility "Sacred Heart" was properly closed.

LPA also spoke with facility TV. Per Administrator, technical support is at the facility once a month but is not associated as a staff member because his role is to assist with documentation and their online program. LPA was able to confirmed their clearance through the department and advised Administrator to have them associated to the facility.

There were no deficiencies noted at the time of the visit. An exit interview was conducted, and a copy of this report was reviewed and provided to facility administrator, Yazmine Cerda.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira Arreola	TELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

LIC809 (FAS) - (06/04)

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