374603112-5-13-2024-08-AS-AROS-D58QRT-20240513122428

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374603112
Report Date: 05/13/2024
Date Signed: 05/13/2024 12:24:46 PM

Document Has Been Signed on 05/13/2024 12:24 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	TWAIN RESIDENTIAL CARE, LLC		FACILITY NUMBER:	374603112
ADMINISTRATOR:	SIMSUANGCO, LEONARDO		FACILITY TYPE:	740
ADDRESS:	4626 TWAIN AVE		TELEPHONE:	(619) 281-8337
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92120
CAPACITY:	12	CENSUS: 12	DATE:	05/13/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:51 AM
MET WITH:	Administrator Chona Simsuango		TIME COMPLETED:	01:00 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) Amy Rodgers conducted an unannounced required annual inspection. LPA introduced herself and was granted entry into the facility by Mila Manansala, Staff, to whom LPA disclosed the purpose of the visit. The licensees, Leonardo and Chona Simsuangco, arrived a short time later.

According to the facility’s license, the facility has a maximum capacity of twelve (12) residents, all of whom may be non-ambulatory. During today’s inspection, there were a total of twelve (12) residents residing in the home.

LPA, accompanied by facility staff, toured the interior and exterior of the facility, and inspected each room. The facility was clean and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors and equipment inspected were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. Hot water temperature at sink accessible to clients measured at in both building were compliant..

Refrigerators and freezers were operational. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Medications were labeled, as required, and stored in a locked closet.

[Continued on 809-C]
.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: TWAIN RESIDENTIAL CARE, LLC	FACILITY NUMBER: 374603112
	VISIT DATE: 05/13/2024

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
26
27
28
29
30
31
32

[Continued from 809]

No pools or bodies of water were observed on the premises. Per the licensee, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, and facility telephone were in working order. Fire extinguishers were serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA interviewed staff and clients. The interviews did not raise any licensing concerns. LPA reviewed records/files. Staff are current on training requirements. Staff files contained required documents. Confidential records were stored in locked cabinets.

No deficiencies were observed or cited during today's annual inspection.

An exit interview was conducted with Chona Simsuangco, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the end of the visit.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2