331881264-1-12-2024-18-AS-SMAZ-CZETXL-20240112140720

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331881264
Report Date: 01/12/2024
Date Signed: 01/12/2024 02:07:28 PM

Document Has Been Signed on 01/12/2024 02:07 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	BIANCA'S HOME CARE 2		FACILITY NUMBER:	331881264
ADMINISTRATOR:	DAO, BREVET		FACILITY TYPE:	740
ADDRESS:	12432 BOUGAINVILLEA WAY		TELEPHONE:	(714) 507-8040
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92503
CAPACITY:	6	CENSUS: 5	DATE:	01/12/2024
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	08:58 AM
MET WITH:	Brevet Dao, Administrator		TIME COMPLETED:	02:20 PM

NARRATIVE

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Licensing Program Analyst (LPA), Stephanie Martinez, returned to the home on the above date to continue the annual inspection that was started on 12/29/2023. The visit was unannounced. The LPA met with Administrator, Brevet Dao, shortly after the start of the visit.

Food Service: There is a minimum of 2 days of perishable foods and 1 week's supply of non-perishable foods available. All readily perishable food or beverages capable of growth of micro-organisms are being stored in covered containers at appropriate temperatures. The kitchen was observed to be maintained in a clean and organized state.

Record Review: Staff have criminal record clearances, all staff were observed to have appropriate fingerprint clearances. LPA did not observe any excluded individuals on the premises at time of visit. Staff responsible for direct care and supervision have current first aid training.

Administration: There is a disaster and mass casualty plan in place. The facility has an approved hospice waiver for six (6) residents. All services requiring specialized skill are being performed by personnel qualified as appropriately skilled professionals.

Medical Related Services: There are no persons who have a prohibited health condition admitted at the facility. The LPA conducted a medication audit and observed violations; medications were being transferred from their original containers into weekly medication containers. This poses a potential threat to the health and safety of residents in care. A citation will be issued.

An exit interview was conducted with Administrator Dao; this report was reviewed and a copy was provided.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Stephanie Martinez	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024

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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Document Has Been Signed on 01/12/2024 02:07 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BIANCA'S HOME CARE 2	FACILITY NUMBER: 331881264
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/12/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87309(a)

STORAGE SPACE: 87309(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above. Multiple chemicals were found to be accessible to unauthorized individuals throughout the facility. Fabuloso, an all purpose cleaner, Comet, Lysol, Clorox, Ajax, and other chemicals were all observed to be accessible. This posed a potential health and safety risk to persons in care.
	POC Due Date: 12/29/2023
	Plan of Correction
1 2 3 4	Chemicals were made inaccessible during initial visit on 12/29/2023. POC cleared.

Type B

Section Cited

CCR

87465(h)(5)

INCIDENTAL MEDICAL AND DENTAL CARE: The following requirements shall apply to medications which are centrally stored: Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in four out of four residents whose medications were being transferred from their original containers to a weekly medication container more than twenty-four hours in advance. This poses a potential health and safety risk to persons in care.
	POC Due Date: 01/19/2024
	Plan of Correction
1 2 3 4	Administrator Dao stated in-service training, regarding medication procedures, will be provided by a third party by the above date.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Stephanie Martinez	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024

LIC809 (FAS) - (06/04)

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