421700160-10-12-2022-29-AS-DCOZ-CK5QXR-20221012123359

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 421700160
Report Date: 10/12/2022
Date Signed: 10/12/2022 12:34:50 PM

Document Has Been Signed on 10/12/2022 12:34 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
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	CASA DORINDA		FACILITY NUMBER:	421700160
ADMINISTRATOR:	BRIAN MCCAGUE		FACILITY TYPE:	741
ADDRESS:	300 HOT SPRINGS RD.		TELEPHONE:	(805) 969-8011
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93108
CAPACITY:	325	CENSUS: 346	DATE:	10/12/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Therese Brown, Senior Director of Health Services		TIME COMPLETED:	12:45 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) Cortez and Olson conducted an unannounced infection control annual inspection. LPA's met with Administrator and Senior Director of Health Services around 10:20 AM and explained purpose of the visit. Currently, there are 346 residents living within the community. There are 312 residents residing in Independent Living, 25 residents residing in the Assisted Living area of the community, and 9 residents residing in the memory care unit of the community. LPA's Olson and Cortez took a physical plant tour of the facility with Assisted Living and Memory Care from 10:30 AM to 11:30 AM This facility consists of Independent Living section and Memory Care. Medications are kept in a locked medication room. Main kitchen, dining rooms, various activity rooms were toured. The kitchen was inspected for cleanliness and sanitary condition. The facility has multiple areas spaced to accommodate as much space as possible for social distancing. The staff screen residents for symptoms and temperature at least once a day and documentation is kept on file. Increased monitoring is conducted if any change of condition are noted or any residents are showing any signs, symptoms or a temperature.. Continued on 809-C

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Diego Cortez	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: CASA DORINDA	FACILITY NUMBER: 421700160
	VISIT DATE: 10/12/2022

NARRATIVE

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Staff makes sure residents have a mask when leaving the facility on outings into the community. All staff wear face coverings in the facility and when on outings with residents. Facility have areas for visiting inside and outside. The facility also offers virtual and telephone communications to all residents in care. Staff, Residents and visitors are informed of the facilities infection control policies. New residents and staff will be tested and negative results received before working or residing in the facility. The facility has procedures and plans for screening, isolation, testing, when to call 911 and notifying all responsible parties and agencies when needed.

Senior Director of Health Services is in charge of infection control and provides training and education to staff, residents and visitors. Staff will use full PPE with N95 masks and face shields when dealing with any pending or confirmed cases of Covid-19. Facility has plans for delivering medications and meals to any quarantined/isolation resident rooms. Senior Director has a plan in place for when and whom to notify in an outbreak or other emergencies. Sinks were well stocked with soap, paper towels and hand washing signs. Staff and resident records are kept in locked cabinets/offices. Facility does realize guidance changes and the most up to date guidance from CCL-PINS, CDC, CDPH, and local health departments should be followed to remain in compliance. Administrator Certificates are valid. Fire extinguishers were charged and inspected annually. The facility has hardwired smoke and carbon monoxide detectors throughout the facility.

No deficiencies were observed during the visit and all infection control policies are being followed.

Exit interview conducted. Report issued via email.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Diego Cortez	TELEPHONE: (805) 562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022

LIC809 (FAS) - (06/04)

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