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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405802300
Report Date: 01/28/2022
Date Signed: 01/28/2022 05:08:35 PM

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:HOPE ASSISTED LIVINGFACILITY NUMBER:
405802300
ADMINISTRATOR:CASTANIAGA, JANELYNFACILITY TYPE:
740
ADDRESS:1023 SLEEPY HOLLOWTELEPHONE:
(805) 717-4578
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:6CENSUS: 6DATE:
01/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:01 AM
MET WITH:Janelyn Castaniaga, Licensee/AdministratorTIME COMPLETED:
12:45 PM
NARRATIVE
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At 11:01 am, on 1/28/2022, Licensing Program Analyst (LPA) Darlene Chavez conducted an unannounced annual infection control inspection of the facility above. LPA met with Staff #1 (S1) and explained the reason for the visit. LPA and S1 toured the facility. At 11:37 am, Licensee/Administrator Janelyn Castaniaga, arrived at the facility and LPA explained the reason for the visit.

LPA’s initial tour of the facility resulted in observations which were immediately corrected. LPA was screened upon entry to the facility by staff. Licensee has agreed to ensure all staff are fit tested for N95 respirators and provide a certification and staff sign-in sheet. At 11:31 am, LPA observed live-in family member not wearing a mask while washing dishes. Upon finishing the dishes, family member placed a mask on. Staff #2 (S2) was observed wearing a mask below the nose. LPA instructed S2 to pull S2’s mask up and explained the importance of having a secure mask while working with residents in care. S2 immediately pulled up the mask.

At 11:12 am, the kitchen water temperature was recorded at 136.4 F, and between 11:12 am and 11:27 am, the bathrooms’ water temperatures were recorded at: bathroom #1 at 135.7 F, bathroom #2 at 108 F, bathroom #3 at 107 F, and bathroom #4 at 106.8 F. The facility failed to protect the personal rights of residents in care to be able to receive safe and healthful accommodations in that the facility’s water temperatures were recorded beyond 120 F degrees in the kitchen and one bathroom. This is a violation of CCR regulations.

Pursuant to Title 22, California Code of Regulations, the deficiency will be cited on 809-D.

At 11:50 am, LPA conducted the Infection Control mitigation module with the licensee.



Exit interview conducted, deficiency cited, and report and Appeal Rights emailed to the licensee.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2022
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 2
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: HOPE ASSISTED LIVING
FACILITY NUMBER: 405802300
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Section Cited
Deficient Practice Statement
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80088(e)(1) Furniture, Fixtures, Equipment, and Supplies. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).
Based on observations, the facility failed to ensure that the facility’s water temperatures were maintained at a temperature of 105 F to 120 F which poses an immediate health and safety risk to residents in care.
POC Due Date: 01/29/2022
Plan of Correction
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Licensee will immediately adjust hot water temperature to ensure the facility's water temperatures record between 105 F and 120 F. Licensee will send a video to LPA by end of business 1/29/22 recording water temperature in the kitchen and each of the four bathrooms.
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: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:
DATE: 01/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/28/2022
LIC809 (FAS) - (06/04)
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