565801462-3-22-2024-29-AS-BBAI-D3LTCM-20240322143659

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801462
Report Date: 03/22/2024
Date Signed: 03/22/2024 02:38:03 PM

Document Has Been Signed on 03/22/2024 02:38 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: 3	DATE:	03/22/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Viveca Lim - Administrator		TIME COMPLETED:	03:00 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 Analyst (LPA) Brian Balisi arrived at the facility unannounced to conduct a required annual inspection. Upon arrival LPA met with Administrator Viveca Lim and explained the reason for the visit. At approximately 09:45am, LPA 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. The carbon monoxide and smoke alarms were tested and all functioned properly. The fire extinguisher's were fully charged and last serviced in 01/05/2024. The kitchen appeared to be clean and the appliances and fixtures functional. LPA observed a sufficient amount of perishable food stored in the fridge and non-perishable food properly stored. Kitchen knives are stored in a locked drawer to the left of the sink. Stove burners are rendered inaccessible to the residents by by removing knobs when not in use. The supply of dishes, utensils, pots, pans and drinkware is adequate. The freezer was maintained at zero degrees Fahrenheit (0F) and the refrigerator was maintained at 40F. The supply of nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen, laundry and house cleaning supplies are stored in the laundry area. This area was observed inaccessible to residents in care. No flies or other vermin were observed. All resident rooms are set up with beds, night stands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024

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: A NURTURING TOUCH	FACILITY NUMBER: 565801462
	VISIT DATE: 03/22/2024

NARRATIVE

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Continued from 809

In addition, no bedroom was used as a passageway to another room, bath or toilet. Room #5 is a designated staff room. LPA observed it to be empty and inaccessible to residents in care at this time. All rooms were free of odors. All window screens were clean and maintained in good repair. LPA observed all bathrooms in each resident bedroom were clean, properly supplied and had functional fixtures. The hot water was measured in each bathroom within 105 - 120 degrees Fahrenheit.

Common Areas: These included the living rooms and dining areas. The common areas were properly furnished and appeared to be relatively clean at this time.

The exterior passageways were clean and clear of any obstructions. There is a covered patio area at the back of the house with tables and chairs where residents can sit. The entire property is not fenced. The back and sides of the house are separated from the front yard by gates at the east and west side passageways. There is a door w/gate with a self-latching mechanism for persons to enter the back yard. There are no other structures on the property. There are no bodies of water on the premises at the present time. The garage was observed to be inaccessible to residents. LPA observed the garage to store, Personal Protective Equipment, incontinent supplies, toiletries, laundry area, extra food storage and other materials / equipment for facility use

Records review began at 11:00am, three (3) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. (4) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were observed to be in order at this time. Last emergency / disaster drill was conducted on 01/08/2024.

Medications review began at approximately 1:00pm The medications are centrally stored in a locked cabinet in the kitchen inaccessible to residents in care. Medications were observed to be properly documented on the centrally stored medications and destruction record at this time.

Between 9:30am - 3:30pm, LPA interviewed residents and staff.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024

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: A NURTURING TOUCH	FACILITY NUMBER: 565801462
	VISIT DATE: 03/22/2024

NARRATIVE

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Continued from 809-C

During today’s visit, LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and a sanitation station. LPA observed 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 a communicable disease. The facility has not had a confirmed case of a communicable disease at this time; however, the facility’s policies and procedures as it pertains to infection control are adequate at this time.

LPA obtained the following documents - Census, Staff schedule, and Limited Liability insurance.

Exit interview conducted and a copy of report was provided

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024

LIC809 (FAS) - (06/04)

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