374601445-11-15-2024-18-AS-VMIN-DB2SDV-20241115124747

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374601445
Report Date: 11/15/2024
Date Signed: 11/15/2024 12:47:55 PM

Document Has Been Signed on 11/15/2024 12:47 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 TOUCH II		FACILITY NUMBER:	374601445
ADMINISTRATOR/ DIRECTOR:	LUZ VELASCO		FACILITY TYPE:	740
ADDRESS:	138 BELLERIVE DR		TELEPHONE:	(760) 715-0529
CITY:	VISTA	STATE: CA	ZIP CODE:	92084
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 4	DATE:	11/15/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:59 AM
MET WITH:	ADMINISTRATOR, LUZ VELASCO		TIME VISIT/ INSPECTION COMPLETED:	12:59 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	On November 15, 2024, Licensing Program Analyst (LPA), Venus Mixson made an unannounced visit to the facility to conduct an annual licensing inspection, and met with the Administrator, Luz Velasco. The facility file review was conducted at the Regional Office and additional records were requested and reviewed on site. LPA Mixson toured the facility along with the Administrator, and inspected the facility inside and outside, and there were no obstructions to the indoor or outdoor passageways at the time of this visit. The facility is licensed to serve six senior residents and is currently operating at four residents. Physical Plant: The facility is a single-story home located at 138 Bellerive Dr, Vista, Ca. 92084, and the land- line phone number is (760) 715-0529 and is operable. LPA observed a sample of the resident's bedrooms, and each was equipped with required furniture as per Title 22. LPA inspected the facility bathrooms, and the hot water temperature tested within regulations. The bathrooms were clean, and appliances were operating appropriately at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers, and a first aid kit with manual. LPA observed required postings such as the Ombudsman poster, "If you See Something, Say Something" and the "Personal Rights" postings were posted in a common area. The cleaning supplies and sharp items were kept locked and inaccessible to the residents. There was a designated space for the resident and staff files, and it was locked, and inaccessible to the residents.

Jazmond D Harris	TELEPHONE: (951) 248-0318
Venus Mixson	TELEPHONE: (951) 897-7936
	DATE: 11/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024

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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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 TOUCH II	FACILITY NUMBER: 374601445
	VISIT DATE: 11/15/2024

NARRATIVE

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Medications: The medications were, locked, and inaccessible to the residents. The overall facility is clean, and the furniture is in good condition. The facility heating system and other appliances were operable currently at the time of this visit.

Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there were a variety of food types. Dishes and utensils are in sufficient supply and stored properly.

Care & Supervision: The facility has sufficient staff, two staff at the time of this visit, and the staff were attentive and engaging the resident’s noon day meal, medication management, and daily activities.

Records Review: LPA reviewed four resident files, three staff files, and conducted one staff interview, and one resident interview.

There was Title 22, Division 6 Regulation violations observed and cited during today’s visit. Pertaining to the annual training regulations as they relate to the staff training in Hospice care to residents, missing two of the four required hours.

An exit interview was conducted, and a copy of this report was discussed and given to the Administrator, Luz Velasco.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus Mixson	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/15/2024 12:47 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ANGEL'S TOUCH II	FACILITY NUMBER: 374601445
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

Other Provisions

(c) The training shall include, but not be limited to, all of the following: (7) Dementia care, including the use and misuse of antipsychotics, the interaction of drugs commonly used by the elderly, and the adverse effects of psychotropic drugs for use in controlling the behavior of persons with dementia. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on [ (record review)], the licensee did not comply with the section cited above in [3] out of [total 3] [(staff)] [identifiers] which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 11/30/2024
	Plan of Correction
1 2 3 4	Administrator shared they will complete the required training as soon as possible, fax the sign in sheet of the completed training with the required date and hours, and the trainers information. By the close of business on the listed due date of the POC.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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

Jazmond D Harris	TELEPHONE: (951) 248-0318
Venus Mixson	TELEPHONE: (951) 897-7936
	DATE: 11/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024

LIC809 (FAS) - (06/04)

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