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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405802300
Report Date: 11/10/2022
Date Signed: 11/14/2022 06:43:27 AM


Document Has Been Signed on 11/14/2022 06:43 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, 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:
11/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Lizeth Tunac / House Lead TIME COMPLETED:
12:21 PM
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 At 9:00am on 11/10/2022, Licensing Program Analyst (LPA) Jeffries arrived at the facility unannounced to conduct the annual infection control inspection. LPA was properly screen for infection control mitigation upon entrance to the facility. LPA met with House Lead Care Giver Lizeth Tunac (S1) and announced who he was and the reason for the visit. S1 called Licensee Janelyn Castaniaga and acknowledged that S1 could conduct annual infection control visit and sing for the visit. LPA observed that S1 has an Administrators certificate but is not the designated Administrator of this facility.
S1 and LPA conducted a cursory tour of the facility. LPA noted that the facility has 6 resident bedrooms and 3 bathrooms on the first floor, 4 rooms are single resident occupancy. There are two large living rooms, kitchen, dining room and and outdoor area in the back. There is a locked laundry room on the first floor where chemicals and medications are locked and stored. LPA observed at least seven days of perishable and at least two days of non-perishable foods on hand at the facility. LPA observed fire extinguisher to be in the green and stamped current. LPA observed a 30 day supply of PPE on hand and 30 days of incontinence supplies on hand at this facility. LPA observed liquid soap and paper towels in all the facility bathrooms. LPA noted that there was no emergency disaster plan posted and no Provider Information Notice (PIN's) that were easily accessible when requested. LPA noted that there were no other visible violations observed during the cursory tour of the facility. LPA issued a Technical Assistance violation for the Emergency disaster plan and the PINs not being accessible. Licensee will print PINs and make them accessible and post Emergency Disaster Plan immediately.
S1 and LPA conducted infection control module of the annual inspection. Two violations noted above are cited.

Exit interview, two Technical Assistance violation issued, report signed, and report emailed.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/10/2022
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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