425800484-9-23-2022-29-AS-KKOS-CJJVHB-20220923162652

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 425800484
Report Date: 09/23/2022
Date Signed: 09/23/2022 04:27:28 PM

Document Has Been Signed on 09/23/2022 04:27 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:	ABUNDANT CARE		FACILITY NUMBER:	425800484
ADMINISTRATOR:	TIMOTHY PRYKO		FACILITY TYPE:	740
ADDRESS:	5506 SOMERSET DRIVE		TELEPHONE:	(805) 576-7470
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93111
CAPACITY:	6	CENSUS: 5	DATE:	09/23/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Timothy Pryko, Administrator		TIME COMPLETED:	03:15 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 (LPAs) Diego Cortez and Kristin Kontilis conducted an unannounced Annual Required visit and inspection of the facility. LPAs arrived at 1:46 pm and were greeted by Staff 1 (S1) on duty. Upon arrival, there was one staff on duty and five residents in care. Timothy Pryko arrived at approximately 1:47 pm. LPA explained the purpose of the visit. Entrance interview conducted. There are currently 5 residents residing in the facility. The facility is home to residents with a dementia diagnosis. There are currently no residents on hospice. A tour of the physical environment and accommodations were assessed, and the following was noted: LPA observed the required posting of the complaint poster, bill of rights and Resident’s Rights. LPA inspected the one-story facility for fire safety, personal accommodations, and food service. First aid kit was observed to be complete. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked. The facility was seen to be in good repair inside and outside. Fire inspection was conducted on 9/1/2022. The carbon monoxide alarm and smoke alarms are in good working order. Medications are kept in a locked centrally stored cabinet. The backyard has a covered patio with outdoor furniture. There are no bodies of water. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. A locked private staff room is located in the main part of the house near the front entrance. The living room and dining area are neat and clean. The facility maintains a comfortable temperature at 74.0 degrees Fahrenheit (F). Hallways, bedroom doors and walls are in good repair. The facility has 5 private bedrooms with private baths. Bedroom #1 is a private bedroom with access to the bathroom across the hallway. Each resident’s room is furnished with overhead lights to provide sufficient lighting, a night stand, and a bed. Please continue to 809-C, Pg 2.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022

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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ABUNDANT CARE	FACILITY NUMBER: 425800484
	VISIT DATE: 09/23/2022

NARRATIVE

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The bathrooms have secure grab bars and no skid flooring.
LPAs advised Administrator that COVID-19 screenings should be done with all visitors, staff, and residents who return from outings upon entry into the facility. LPAs advised Administrator that CDSS PINs and CDSS PIN summaries should be readily available to residents, staff, and visitors. LPAs advised Administrator that visitation policies and COVID-19 awareness posters should be made available prior to entering the facility.
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. Signs are posted on the front door, entry area regarding Covid-19.
Staff ensure 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 has 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.
Administrator 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. Facility Administrator 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 offices. Facility recognizes that 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. The most stringent orders should be followed by any of these agencies. Administrator’s Certificate is valid. Fire extinguishers were charged and inspected annually. The facility has hardwired smoke detectors thorough the facility.
At approximately 2:07 pm, LPAs reviewed Department of Social Services, Community Care Licensing Division, Licensing Information System (LIS), Facility Personnel and facility staff roster and determined all staff have completed a criminal background clearance and are properly associated to the facility.
Exit interview conducted. No deficiencies cited. A copy of this report is issued via email.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2022

LIC809 (FAS) - (06/04)

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