374603444-1-25-2024-08-AS-DSEA-CZTP5T-20240125100113

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374603444
Report Date: 01/24/2024
Date Signed: 01/25/2024 10:01:29 AM

Document Has Been Signed on 01/25/2024 10:01 AM - 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	OPALEC BOARD AND CARE		FACILITY NUMBER:	374603444
ADMINISTRATOR:	LEANN COX OPALEC		FACILITY TYPE:	740
ADDRESS:	5638 PLUMAS STREET		TELEPHONE:	(619) 434-6366
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92139
CAPACITY:	6	CENSUS: 6	DATE:	01/24/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Lilia Opalec, Licensee		TIME COMPLETED:	05:10 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) Dawn Segura conducted an unannounced required annual inspection. LPA identified herself and was granted entry into the facility. Licensee, Lilia Opalec, to whom LPA disclosed the purpose of the visit, arrived a short time later. According to the facility’s license, the facility is licensed for six (6) residents, all of whom may be non-ambulatory. During today’s inspection, there were six (6) residents in care. The facility also has an approved waiver for 3 hospice residents. LPA, accompanied by licensee, toured the interior and exterior of the facility. Pathways were free of obstruction and slip hazards. Doors, windows and screens were present and sinks and toilets were in working order. Hygiene supplies and Personal Protective Equipment were present. The facility had sufficient space and equipment to facilitate visitation, meetings, and activities. Hot water temperature in bathroom sinks in bathrooms that are used by residents initially measured at 152.3 and 153.1 degrees Fahrenheit. The hot water heater was adjusted during the visit and signs advising of the high hot water temperatures were posted in each bathroom. Hot water temperature measured at 141.2 degrees Fahrenheit at the end of the visit. There were no sharp objects or open-faced heaters accessible to residents; however, LPA observed Comet cleanser with bleach stored in a kitchen cabinet that was accessible to residents with a diagnosis of dementia. A fireplace with appropriate screening was observed in the living area of the home. 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 detector, and facility telephone were all working.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn Segura	TELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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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Document Has Been Signed on 01/25/2024 10:01 AM - 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: OPALEC BOARD AND CARE	FACILITY NUMBER: 374603444
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87303(e)(2)

Maintenance and Operation

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in 2 of 2 bathrooms which poses immediate health and safety risks to 6 of 6 persons in care.
	POC Due Date: 01/25/2024
	Plan of Correction
1 2 3 4	Hot water heater was adjusted during the visit. Signs were posted in each bathroom advising of the high water temperatures. Licensee offered to continue to measure the water temperature and maintain a log of temperatures for a week to ensure that the hot water drops to and remains at a level within the regulatory range.

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.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn Segura	TELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: OPALEC BOARD AND CARE	FACILITY NUMBER: 374603444
	VISIT DATE: 01/24/2024

NARRATIVE

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Refrigerator and freezer 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. Medications were labeled, as required, and stored in locked cabinets. First aid kit was complete and readily accessible.

LPA interviewed staff and clients. LPA also reviewed staff and client records/files. Resident 1’s (R1) file contained a Physician’s Report; however, the last two pages of the report were missing. Staff file contained proof of current first aid and negative TB test result. Confidential records were stored in locked area.

Deficiencies were cited during today's visit, and plans of correction were jointly developed with the licensee. An exit interview was conducted with Lilia Opalec, to whom a copy of this report, the LIC 809-D, LIC 9102TAs, LIC 9102TV, the LIC 811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the end of the visit.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn Segura	TELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 01/25/2024 10:01 AM - 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: OPALEC BOARD AND CARE	FACILITY NUMBER: 374603444
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87309(a)

Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in 1 toxic chemical which posed a potential health risk to 3 of 6 persons with dementia in care.
	POC Due Date: 02/02/2024
	Plan of Correction
1 2 3 4	The Comet cleanser was immediately removed and stored in a locked cabinet. Licensee offered to ensure that staff training is provided and proof of training submitted to Community Care Licensing by the POC due date.

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.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn Segura	TELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

LIC809 (FAS) - (06/04)

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