374604434-6-13-2023-08-AS-RGAZ-CSRQUB-20230613122829

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604434
Report Date: 06/13/2023
Date Signed: 06/13/2023 12:28:41 PM

Document Has Been Signed on 06/13/2023 12:28 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
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	GALINDO HOME CARE INC.		FACILITY NUMBER:	374604434
ADMINISTRATOR:	TORRES, ERNESTINA		FACILITY TYPE:	735
ADDRESS:	3447 LAS VEGAS DR		TELEPHONE:	(442) 266-2914
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92054
CAPACITY: 3		CENSUS: 2	DATE:	06/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Co-Administrator Princess Torres		TIME COMPLETED:	12:40 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) Riza Alvarez conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Co-Administrator Princess Torres. According to the facility’s license, the facility has a maximum capacity of three (3) ambulatory clients. During today’s inspection, there is one (1) client in care, the other client is out in day program. The facility fire clearance did not include permissions for secured perimeter or delayed egress doors, and none of these were present during today’s visit. LPA, accompanied by P Torres, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and generally in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. Hot water temperatures at taps accessible to clients were compliant: Kitchen sink was 110 F, Bathroom #1 sink was 110 F, and Bathroom #2 sink was 107 F. The facility’s ambient internal temperature was compliant at 69 F. Kitchen refrigerator temperatures was complaint at 39 F. 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. Kitchen appliances were working. [CONTINUED ON LIC 809-C]

SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Riza Gloria Alvarez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

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

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: GALINDO HOME CARE INC.	FACILITY NUMBER: 374604434
	VISIT DATE: 06/13/2023

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 LIC 809]

There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas. Confidential staff and client records were stored in locked areas.

No pools or bodies of water were observed on the premises. Per P Torres, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher was 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. Licensees presented proof of current/active business liability insurance and surety bond.

LPA interviewed staff and client present. LPA reviewed all client and staff records/files. LPA interviews did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in locked areas.

Deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D page). A Plan of Correction was jointly developed with the Co-Administrator.

An exit interview was conducted with Co-Administrator Princess Torres, to whom a copy of this report, the LIC 809-D page, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Riza Gloria Alvarez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 06/13/2023 12:28 PM - It Cannot Be Edited

Created By: Riza Gloria Alvarez On 06/13/2023 at 11:59 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: GALINDO HOME CARE INC.	FACILITY NUMBER: 374604434
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80087(a)

Building and Grounds

(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation, the licensee did not comply with the section cited above in one (1) out of eight (8) window screens which poses a potential health risk to persons in care.
	POC Due Date: 06/20/2023
	Plan of Correction
1 2 3 4	Licensee will submit to CCL receipts and photo of repaired window screen.

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:

John Rante

LICENSING EVALUATOR NAME:

Riza Gloria Alvarez

LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3