405800142-1-30-2024-29-AS-JOLN-CZZ3X4-20240130173744

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 405800142
Report Date: 01/30/2024
Date Signed: 01/30/2024 05:38:20 PM

Document Has Been Signed on 01/30/2024 05:38 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	CASA DE FLORES		FACILITY NUMBER:	405800142
ADMINISTRATOR:	JONATHAN D. ROBERTS		FACILITY TYPE:	741
ADDRESS:	1405 TERESA DRIVE		TELEPHONE:	(805) 772-7372
CITY:	MORRO BAY	STATE: CA	ZIP CODE:	93442
CAPACITY:	120	CENSUS: 79	DATE:	01/30/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:23 AM
MET WITH:	Jonathan Roberts, Administrator		TIME COMPLETED:	06:00 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 Analysts (LPA's) Jenny Olson and Erika Miller arrived at the facility unannounced to conduct a required annual visit. LPA's were greeted by Administrator and informed them of the reason for the visit. From 10:50-11:50 a.m. LPAs conducted a tour of the physical plant with Administrator and Director of CCRC Operations to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The following was noted: Facility is a double-story residence that consists of an assisted living unit. LPAs observed fire extinguishers throughout the facility, which were fully charged and last serviced on 4/25/2023. The Administrator provided an annual fire alarm testing and inspection report done on 04/27/2023 where all smoke alarms were tested and functioned properly. LPA observed all required postings near the entrance area. Carbon Monoxide detectors were tested and operational at the time of the visit. Kitchen: During the facility tour, the kitchen appeared clean and the appliances and fixtures functional. LPAs observed a sufficient amount of perishable and non-perishable food at the facility. Food is prepared based on the menu. Fruit is available in the second floor media room and beverages are available for residents in the large dining room. Bedrooms: During today’s visit, LPA Olson observed ten (10) randomly selected resident units. The resident bedrooms were properly furnished. Bathrooms: LPA Olson observed all bathrooms, which were properly supplied and had functional fixtures. LPA observed non-skid shower floors in all bathrooms. Out of the ten (10) bathrooms observed, two (2) toilets required cleaning. Upon observation, staff cleaned the areas. Continued on LIC809-C.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: CASA DE FLORES	FACILITY NUMBER: 405800142
	VISIT DATE: 01/30/2024

NARRATIVE

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Common Areas: These included the beauty salon, library, activity room, theater, fitness center, Frannies Ice Cream Shop, and dining areas. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. Fireplaces were properly screened.

Surrounding Grounds (Outdoors): LPAs observed appropriate outdoor furniture in multiple areas which had umbrellas and shaded area for residents. Parking is available for residents and visitors.

Infection Control: The community's policies and procedures pertaining to infection control were adequate.

Record Review: A review of facility files was initiated. LPA Olson reviewed five (5) of seventy nine (79) Resident files. All resident files were complete.

MEDICATION AUDIT: A medication audit for two (2) residents was initiated and the following was observed. The medications were stored in the medication carts, which was locked and inaccessible to the residents.

LPAs interviewed 5 residents and one staff.

Due to time restraints LPAs will need to return at a later date.

Exit interview conducted and copy of the report was provided.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette Olson	TELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC809 (FAS) - (06/04)

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