374603810-9-10-2024-08-AS-DNGN-D8YUCM-20240910152809

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374603810
Report Date: 09/10/2024
Date Signed: 09/10/2024 03:28:34 PM

Document Has Been Signed on 09/10/2024 03:28 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	OHANA CARE HOME		FACILITY NUMBER:	374603810
ADMINISTRATOR:	ISO, SEIKO		FACILITY TYPE:	740
ADDRESS:	8569 INNSDALE LANE		TELEPHONE:	(619) 259-2125
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92114
CAPACITY:	6	CENSUS: 0	DATE:	09/10/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Licensees Frank Ramirez and Seiko Iso		TIME COMPLETED:	03:30 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) Dang Nguyen conducted an unannounced visit to conduct a Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Licensees Frank Ramirez and Seiko Iso. According to the facility’s license, the facility has a maximum capacity of six (6) residents, of which all may be ambulatory or non-ambulatory but none may be bedridden. Per LPA observation and staff interviews, During today’s inspection, there were zero (0) residents in care. The facility’s license does not include endorsements for delayed-egress doors or secured perimeter, and none of these were present. LPA, accompanied by Licensee’s staff, toured the interior and exterior of the facility, and inspected all common areas and resident rooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Doors, windows and screens, toilets, and showers were working. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility’s ambient internal temperature was complaint at 73 F. Hot water temperature at all taps were compliant: Kitchen Sink was 113.2 F, Bathroom #1 Sink was 113.5 F, and Bathroom #2 Sink was 110.8 F. Appliances to preserve perishable food were also all compliant in temperature: Kitchen Refrigerator was 35 F and Kitchen Freezer was 0 F. Garage Freezer was 0 F. There was at least two (2) days of perishable food, and at least seven (7) days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. [CONTINUED ON LIC 809-C]

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

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

FACILITY NAME: OHANA CARE HOME	FACILITY NUMBER: 374603810
	VISIT DATE: 09/10/2024

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[CONTINUED FROM LIC 809]

There were no sharp objects, toxic chemicals/poisons, active fireplaces, or open-faced heaters left accessible to potential residents. There were locked areas for storage of medications and confidential records. 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, night lights, emergency lighting, and facility telephone were all working. The facility’s fire extinguisher was in good condition. Required licensing postings were observed in visible areas of the facility.

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

An exit interview was conducted with Ramirez and Iso, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2024

LIC809 (FAS) - (06/04)

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