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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405850222
Report Date: 12/17/2022
Date Signed: 02/02/2023 03:00:13 PM


Document Has Been Signed on 02/02/2023 03:00 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:LIFETOUCH THE ELEGANT LIVING RESIDENTIAL HOME CAREFACILITY NUMBER:
405850222
ADMINISTRATOR:AQUINO, AMELITA I.FACILITY TYPE:
740
ADDRESS:1934 TULIPWOOD DRIVETELEPHONE:
(805) 878-3409
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY:6CENSUS: 5DATE:
12/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Dennis Paguio/House LeadTIME COMPLETED:
12:45 PM
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 At 11:30am on 12/17/2022, Licensing Program Analyst (LPA) arrived unannounced at the facility to conduct the an infection control annual inspection. LPA met with House Lead Dennis Paguio (S1) and announced who he was and the reason for the visit. S1 contacted Licensee Amelita Aquion by phone and provided verbal authorization for S1 to conduct and sign the annual inspection report.

S1 and LPA conducted a cursory tour of the facility. LPA observed the facility have two days of perishables and seven days of non-perishable foods. LPA observe fire detectors and carbon monoxide detectors to be working throughout the facility. LPA observed the bathrooms to be stocked with appropriate supplies including liquid soap and paper towels. LPA observed at least 30 days supply of PPE to be on hand in the dining room cabinet and the garage storage area. LPA did not observe Provider Information Notices (PINs) posted or easily accessible. LPA requested that the PINs be printed and easily accessible by Monday 12/19/2022. LPA noted that the facility was clean and free of hazards and no obstructions to any exits. LPA noted that the outside temperature was <43* f and the facility temperature was a comfortable 74*f. LPA did not observe any issues that would put resident in harm during the cursory inspection tour of the facility.
S1 and LPA conducted the annual infection control module of the annual inspection. LPA noted that two Technical Assistance violations, (1) Provider Information Notices (PINs) were not available and (2) no list of PPE supplies were on hand. S1 will communicate to Licensee that these two TA should be fixed by 12/19/2022. LPA did not note any other violations during the annual infection control inspection.

Exit interview, Technical Assistance Noted, report singed, and report emailed.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 12/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/17/2022
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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