366411294-7-15-2022-56-AS-BALN-CGCSYB-20220715141715

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 366411294
Report Date: 07/15/2022
Date Signed: 07/15/2022 02:17:23 PM

Document Has Been Signed on 07/15/2022 02:17 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
, CA 92507

FACILITY NAME:	EUROPEAN HOME CARE III		FACILITY NUMBER:	366411294
ADMINISTRATOR:	GLEN BERNAL		FACILITY TYPE:	740
ADDRESS:	355 FRANKLIN AVE		TELEPHONE:	(909) 213-1000
CITY:	REDLANDS,	STATE: CA	ZIP CODE:	92373
CAPACITY:	6	CENSUS: 5	DATE:	07/15/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:29 PM
MET WITH:	Ella Agdaca -support staff		TIME COMPLETED:	02:35 PM

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Licensing Program Analyst (LPA) Bernadette Allen made an unannounced visit to the facility to conduct an annual inspection focused on infection control. At 12:29AM, LPA was greeted and granted entry into the facility by support staff Ella Agdaca who was informed of the purpose of the visit. At the time of visit there was 2 staff members and 4 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 posted throughout the facility. The facility has an adequate amount of hand hygiene supplies (soap, hand sanitizer).

LPA Allen, will be issuing a Technical Assistance (TA) Advisory Note during today's inspection staff members were not wearing face covering (surgical mask). Staff immediately applied face coverings (surgical mask).

Staff member were asked about being fit tested for N95 and they stated they haven’t been fit tested for N95 masks. LPA Allen, will not be issuing a deficiency for this item due to the facility not currently having any COVID-19 positive residents, and N95 masks only needing to be worn when a resident is COVID-19 positive or under observation while awaiting test results. LPA provided staff members with provider Information Notice (PIN) PIN-21-10-ASC which contains resources for getting staff fit tested for N95 masks.

The facility staff has a plan to manage Covid-19 symptoms, which includes staff monitoring 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 staff are responsible for cleaning and disinfecting the highly touched surfaces during their shift.

LPA toured the facility inside and out and there were no health and safety concerns. The outdoor and indoor hallways were also free of obstruction.

Continued

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022

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
, CA 92507

FACILITY NAME: EUROPEAN HOME CARE III	FACILITY NUMBER: 366411294
	VISIT DATE: 07/15/2022

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The clients rooms had the required furniture and sufficient lighting. The bathrooms can accommodate the needs for bathing and showers and have non-slip flooring. The facility had a supply of additional linen and extra hygiene items for the clients.

LPA measured the hot water temperature at degrees 112.4 F. LPA observed hand sanitizer throughout the facility.

The facility has charged fire extinguishers, operating smoke alarms, and carbon monoxide detectors at the facility.

An exit interview was conducted with support staff Ella Agdaca where this report was discussed and provided.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022

LIC809 (FAS) - (06/04)

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