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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603156
Report Date: 11/28/2023
Date Signed: 11/28/2023 12:05:44 PM


Document Has Been Signed on 11/28/2023 12:05 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:SENIOR CARE & COMFORT LIVINGFACILITY NUMBER:
374603156
ADMINISTRATOR:LOGALLA, BRANDONFACILITY TYPE:
740
ADDRESS:1019 GREENFIELD DRIVETELEPHONE:
(619) 334-3775
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY:6CENSUS: 6DATE:
11/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Licensee Brandon LogallaTIME COMPLETED:
12:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Required Annual Inspection visit. The facility file was reviewed prior to the visit. The LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Licensee Brandon Logalla. The facility was licensed for a capacity of six (6) Elderly non-ambulatory residents. At the time of the visit the facility had six (6) residents.


Accompanied by Licensee Logalla, the LPA toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Toilets, and showers were in working order and extra linens were observed to be present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, and meetings.

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 toxic chemicals/poisons accessible to clients. Medications were stored, and locked inaccessible to residents.



No pools, nor bodies of water were observed on the premises . Per staff, no firearms, nor ammunition were kept at the facility. Fire extinguisher(s) were present, and required licensing postings were observed in visible areas of the facility.

LPA interviewed staff and reviewed multiple staff and client records/files. The files which the LPA reviewed were missing documents, including first aid certificates, and resident's physician's reports. Additionally, the facility did not have an infection control plan in place. These deficiencies were cited in an LIC 809D and a plan of correction was jointly formulated with the licensee.

An exit interview was conducted with Licensee Logalla, to whom a copy of this report, the LIC 809D, and the Licensee/Appeal Rights (LIC 9058), were provided.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/28/2023
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 3


Document Has Been Signed on 11/28/2023 12:05 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108


FACILITY NAME: SENIOR CARE & COMFORT LIVING
FACILITY NUMBER: 374603156

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87208(a)(12)
87208 Plan of Operation (a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: (12) The Infection Control Plan pursuant to Section 87470. This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above in, which poses/posed a potential health, safety or personal rights risk to 6 of 6 persons in care.
POC Due Date: 12/28/2023
Plan of Correction
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Licensee agreed to submit an Infection Control Plan to the Department, by 12/28/23.
Type B
Section Cited
CCR
87458(a)
87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, observation and review of records, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to 3 of 6 persons in care.
POC Due Date: 12/28/2023
Plan of Correction
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Liecensee agreed to obtain missing physician's reports for residents, and updated physician's reports for residents with dementia. The Licensee will submit these physician's reports to the LPA, by 12/28/23.
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: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 11/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/28/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3


Document Has Been Signed on 11/28/2023 12:05 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108


FACILITY NAME: SENIOR CARE & COMFORT LIVING
FACILITY NUMBER: 374603156

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/28/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87411(c)(1)
87411 Personnel Requirements - General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and review of records, the licensee did not comply with the section cited above in 2 out of 2 staff, which poses/posed a potential health, safety or personal rights risk to 6 of 6 persons in care.
POC Due Date: 12/28/2023
Plan of Correction
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Licensee agreed to obtain first aid training for the two staff and submit proof to the LPA, by 12/28/23.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 11/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/28/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3