565801462-1-13-2023-29-AS-ASMH-CN2T6Q-20230113132731

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801462
Report Date: 01/13/2023
Date Signed: 01/13/2023 01:28:10 PM

Document Has Been Signed on 01/13/2023 01:28 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:	A NURTURING TOUCH		FACILITY NUMBER:	565801462
ADMINISTRATOR:	VIVECA LIM		FACILITY TYPE:	740
ADDRESS:	79 PINEWOOD		TELEPHONE:	(818) 889-8025
CITY:	OAK PARK	STATE: CA	ZIP CODE:	91377
CAPACITY:	6	CENSUS: 5	DATE:	01/13/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Viveca Lim		TIME COMPLETED:	01:25 PM

NARRATIVE

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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to conduct a required annual visit. This annual had a specific emphasis on infection control practices. The LPA met with staff and explained the reason for the visit. The LPA toured the physical plant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

KITCHEN: At 11:55 a.m., the LPA observed accessible medications on the table. Knives and chemicals are locked inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. BEDROOMS: Rooms #3 and #4 have direct exits to the exterior; however, at the time of the visit, the exits were obstructed. Bedrooms had appropriate furnishings, clean linens and sufficient lighting. RESTROOMS: Resident restrooms were clean and sanitary with grab bars and non-skid surfaces. At 11:57 a.m., the LPA observed accessible cleaning supplies in the bathroom near the front door. At 11:59 a.m., water temperature measured at 112.8 F. The LPA observed hand hygiene signs in all restrooms. COMMON SPACES: Living room and dining furniture were observed to be in good condition. Fire extinguishers were charged. The fireplace is appropriately screened. The backyard had furniture and a covered area for resident use. There were no bodies of water noted.

INFECTION CONTROL: Staff were observed wearing appropriate face masks. There is sanitizer available for use throughout the facility. There is an adequate supply of Personal Protection Equipment (PPE). The facility’s cleaning protocol was sufficient. This facility has records of staff and resident vaccinations. The facility can designate a single-person room to isolate persons if there was a confirmed case of COVID-19 Staff are up to date regarding guidelines around visitation and vaccine requirements. The policies and procedures pertaining to infection control were adequate.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit Interview Conducted. Appeal Rights Discussed. A Copy of the Report Issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

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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Document Has Been Signed on 01/13/2023 01:28 PM - It Cannot Be Edited

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: A NURTURING TOUCH	FACILITY NUMBER: 565801462
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/13/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87705(f)(2)

Care of Persons with Dementia

(f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above, as medications and cleaning supplies were accessible, which poses an immediate health and safety risk to persons in care.
	POC Due Date: 01/13/2023
	Plan of Correction
1 2 3 4	The Administrator agreed to do the following: These items were secured upon observation. Plan of Correction met.

Type A

Section Cited

CCR

87307(d)(6)

87307(d)(6) Personal Accomodations and Services. All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above, as the exits out of Room #3 and #4 were obstructed, which poses an immediate health and safety risk to persons in care.
	POC Due Date: 01/13/2023
	Plan of Correction
1 2 3 4	The Administrator agreed to do the following: 1. Remove the obstructions in Room #3 and #4; inform CCL when this has taken place by 1/13/2023, end of day.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

LIC809 (FAS) - (06/04)

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