565801563-6-27-2022-29-AS-MARO-CFSTTF-20220627150041

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801563
Report Date: 06/27/2022
Date Signed: 06/27/2022 03:01:02 PM

Document Has Been Signed on 06/27/2022 03:01 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:	HAPPY HOME CARE		FACILITY NUMBER:	565801563
ADMINISTRATOR:	KAREN ROSALES		FACILITY TYPE:	740
ADDRESS:	179 NORTHAM AVE.		TELEPHONE:	(818) 219-5998
CITY:	NEWBURY PARK	STATE: CA	ZIP CODE:	91320
CAPACITY:	6	CENSUS: 6	DATE:	06/27/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Karina Antig		TIME COMPLETED:	03:00 PM

NARRATIVE

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Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced for a required 1-year annual inspection today at 1:00 p.m. The LPA was scanned and greeted at the door by staff. The Administrator, Karina Antig arrived shortly after at 1:15 p.m. and was explained the reason for the visit. Entrance interview conducted.

At 1:20 p.m., the LPA began the physical plant tour with the Administrator of the common areas, kitchen area, resident bedrooms, staff room, bathrooms, and outdoor area to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of seven (7) days perishable and two (2) days non-perishable food. The LPA observed all knives and sharps in a drawer next to the kitchen sink locked and inaccessible to residents. Toxins and cleaning supplies were observed locked under the kitchen sink at the time of visit.

BEDROOMS: The LPA observed the resident rooms, which were furnished appropriately with clean linens, furnishings, and sufficient lighting.

RESTROOMS: Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Restrooms are sufficiently stocked with hand liquid soap and paper towels. The appropriate hand-washing signs were observed in the restrooms. Bathrooms were measure for hot water, the first bathroom measured at 105.8 degrees Fahrenheit at 1:25 p.m. and the second bathroom measured at 114.8 degrees Fahrenheit at 1:29 p.m.

…Continued on LIC 809C…

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022

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: HAPPY HOME CARE	FACILITY NUMBER: 565801563
	VISIT DATE: 06/27/2022

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…Continued from LIC 809...

GARAGE AND GROUNDS: The garage is attached to the house and locked at all times. There is one (1) additional refrigerator and one (1) freezer in the garage with perishable items in good condition. The LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. Facility has a adequate amount of emergency food and emergency water. There is a covered patio area with patio furniture including a table and chairs for resident use. Facility has one (1) fence gate that self-latches with clear passageways for emergency exit use. No large bodies of water accessible to residents at the time of visit.

COMMON SPACES: The living and dining areas are clean and properly furnished with seating, a table, and television for resident use. The LPA observed two (2) residents in the living room watching television and one (1) resident in the dining room having lunch. Medications are in a locked cabinet adjacent to the kitchen.

During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. The LPA observed appropriate signage which promoted good hand hygiene, physical distancing, symptoms of COVID-19, and CDSS PINS pertaining to visitation guidelines. The facility has a central entry point for symptom screening, temperature checks, and sanitation station. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The LPA and Administrator discussed staff vaccination requirements. All staff and residents are fully vaccinated. Staff were observed wearing face coverings during time of visit. No identified staffing concerns. The facility is in compliance regarding the requirements for indoor and outdoor visitation. The facility’s policies and procedures as it pertains to infection control are adequate.

Exit interview conducted. No citations issued. A copy of the report was provided via email.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2022

LIC809 (FAS) - (06/04)

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