565801451-5-5-2023-29-AS-TCAA-CRJNFR-20230505102554

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801451
Report Date: 04/28/2023
Date Signed: 05/05/2023 10:26:58 AM

Document Has Been Signed on 05/05/2023 10:26 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:	LONG LIFE HOME CARE		FACILITY NUMBER:	565801451
ADMINISTRATOR:	DELIA D. CAFUIR		FACILITY TYPE:	735
ADDRESS:	1887 CESAR CHAVEZ DRIVE		TELEPHONE:	(805) 604-0321
CITY:	OXNARD	STATE: CA	ZIP CODE:	93030
CAPACITY: 5		CENSUS: 5	DATE:	04/28/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:14 PM
MET WITH:	Melanie Cafuir		TIME COMPLETED:	03:40 PM

NARRATIVE

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Licensing Program Analysts (LPAs) Teresa Camara and KaSandra Lopez arrived at the facility unannounced to conduct a required annual visit at 1:14 p.m. When the LPAs arrived, there was one staff and two clients present. The LPAs were greeted by staff and informed them of the reason for the visit. Co-Administrator Melanie Cafuir arrived shortly thereafter.

The LPAs and the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

KITCHEN: Knives and cleaning supplies are stored inaccessible in a locked cabinet under the sink. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Kitchen was clean and sanitary.

COMMON AREAS: The living room is adjacent to the dining room. Furniture was in good condition. The facility is maintained at a comfortable temperature. There is a fireplace in the living room, which is screened and inaccessible. Smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguishers was fully charged and last serviced 4/14/2023. The LPAs observed required postings throughout the common space.

The backyard has a covered outdoor area equipped with furniture for client use. There is a side gate for client use and is single-latched. No bodies of water noted. The garage and laundry room are kept locked. Cleaning supplies were kept in the laundry room. There is an emergency supply of water and non-perishable food stored in the garage.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

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: LONG LIFE HOME CARE	FACILITY NUMBER: 565801451
	VISIT DATE: 04/28/2023

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BEDROOMS: There are three client bedrooms; one single-occupancy and two double-occupancy. LPAs observed the client bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There was a linen closet in the hallway with extra towels and linens.

RESTROOM: There is one restroom for clients. It was clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature was 105.2 degrees Fahrenheit.

RECORDS: A review of records was started but not completed.

MEDICATIONS: Medications are centrally stored and locked in a cabinet in the dining room; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review.

INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued. LPA will return at a later date to finish the required annual visit.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

LIC809 (FAS) - (06/04)

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