336426686-12-15-2023-18-AS-JGAR-CYJUUG-20231215145331

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336426686
Report Date: 12/15/2023
Date Signed: 12/15/2023 02:53:39 PM

Document Has Been Signed on 12/15/2023 02:53 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:	A PLACE CALLED HOME - LA QUINTA		FACILITY NUMBER:	336426686
ADMINISTRATOR:	LORAINE W. SHOW		FACILITY TYPE:	740
ADDRESS:	81-657 HIDDEN LINKS DR.		TELEPHONE:	(760) 550-9401
CITY:	LA QUINTA	STATE: CA	ZIP CODE:	92253
CAPACITY:	6	CENSUS: 2	DATE:	12/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:29 PM
MET WITH:	Joeann Quijano, Caregiver		TIME COMPLETED:	02:55 PM

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Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced annual required visit. LPA was granted entry and met with Caregiver Joeann Quijano. At the time of the visit there was one (1) staff and one (1) resident present.

The facility is a one story home with (5) bedrooms and (3) bathrooms with attached garage. The residents served are residents 60 and older, all being non-ambulatory. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted staff and resident interviews. LPA observed the following:

Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements. LPA reviewed staff records and found that all staff had infection control training.

Physical Plant: LPA observed the resident bedrooms, and common areas. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. LPA observed outdoor furniture and shaded area for clients. Laundry equipment was observed to be in good working condition. The sharp and dangerous objects were observed to be locked and inaccessible to clients. The hot water was measured at 120.0 F. The smoke detectors and carbon monoxide detectors were operational; however, they were low volume. Licensee agreed to replace all of the smoke/carbon monoxide detectors. A technical violation was issued.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Jesse Gardner	TELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2023

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

FACILITY NAME: A PLACE CALLED HOME - LA QUINTA	FACILITY NUMBER: 336426686
	VISIT DATE: 12/15/2023

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Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods.

Care & Supervision/Administration: Adequate staff are present for the supervision of residents during the visit. LPA also reviewed the staff who were scheduled showing adequate staff coverage. Facility sketch, exit routes, personal rights, complaint information and emergency phone numbers were found posted in the facility. The listed administrator's certificate was expired; however, Licensee produced paperwork that stated that it was submitted to CCL for processing.

Record Review and Resident/Staff Files: LPA reviewed two (2) staff files and training. All staff have criminal clearance and updated training along with CPR/First Aid Certification. Two (2) files were reviewed, and possessed all required paperwork.

Health Related Services/ Incidental Medical Services: All resident medication was locked in a cabinet located in the kitchen. LPA reviewed resident medications for two (2) residents and found all medication listed on Medication Administration Record Sheet (MARS) and all required labeling was found to be in place. Upon inspection, LPA found medication that was being stored outside of its prescribed container. A Technical Violation was issued.

Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies in the kitchen and first aid kit with all required items.

Additionally, the facility's fees were listed as past due, and thus a technical violation was issued.

An exit interview was conducted where a copy of this report was discussed with and provided along with copies of the (3) LIC9102.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Jesse Gardner	TELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2023

LIC809 (FAS) - (06/04)

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