565801896-12-10-2022-29-AS-MARO-CLYUDF-20221210142929

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801896
Report Date: 12/10/2022
Date Signed: 12/10/2022 02:30:19 PM

Document Has Been Signed on 12/10/2022 02:30 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:	LAND OF ENCHANTMENT BOARD AND CARE		FACILITY NUMBER:	565801896
ADMINISTRATOR:	ROXANA LARA		FACILITY TYPE:	740
ADDRESS:	346 E. GAINSBOROUGH ROAD		TELEPHONE:	(805) 379-2185
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	6	CENSUS: 6	DATE:	12/10/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:50 PM
MET WITH:	Roxana Lara		TIME COMPLETED:	02:30 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), Martha Arroyo arrived unannounced to conduct a Required 1-Year Annual Inspection with focus on Infection Control. The last annual conducted at this facility was on 10/03/2019. Upon arrival, the LPA was scanned and greeted at the door by the Administrator, Roxana Lara, at this time, the reason for the visit was explained. Entrance interview. During today’s inspection, the LPA toured the common areas, kitchen area, resident bedrooms, bathrooms, and outdoor area to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: The LPA observed a sufficient supply of seven (7) days perishable and two (2) days non-perishable food. All knives and sharps were observed in a locked drawer on the kitchen island inaccessible to residents in care. BEDROOMS: The LPA observed the resident rooms, which were furnished appropriately with adequate lighting. BATHROOMS: There are two (2) bathrooms for resident use. Bathrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces and are sufficiently stocked with hand liquid soap and paper towels. The appropriate hand-washing signs were observed throughout. Bathrooms were measured for hot water; the first bathroom measured at 127.4 degrees Fahrenheit at 1:18 p.m., and the second bathroom measured at 113 degrees Fahrenheit at 1:24 p.m. The Administrator had the water temperature adjusted at the time of visit. …Report 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: 12/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2022

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: LAND OF ENCHANTMENT BOARD AND CARE	FACILITY NUMBER: 565801896
	VISIT DATE: 12/10/2022

NARRATIVE

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…Report Continued from LIC 809...

GARAGE AND BACKYARD: The garage is locked and inaccessible to residents. There is one (1) additional refrigerator in the garage. The LPA observed a sufficient supply of emergency water and food in the garage. The laundry room is locked and located in the garage. There is a patio area with furniture including a table and chairs for resident use. Facility has two (2) fence gates that self-latch with clear passageways for emergency exit use. There is a pool in the backyard that is locked and inaccessible 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 facility is maintained at 74 degrees Fahrenheit. The fire extinguisher was observed to be newly purchased on 10/20/2022. Medication and facility files were observed locked in a closet adjacent to the living room. INFECTION CONTROL: 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, and symptoms of COVID-19. The facility has a central entry point for symptom screening, temperature checks, and sanitation station. The LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. All staff and residents are fully vaccinated and boosted.

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 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: 12/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/10/2022 02:30 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: LAND OF ENCHANTMENT BOARD AND CARE	FACILITY NUMBER: 565801896
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/10/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87303(e)(2)

Maintenance and Operation

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA observation, the licensee did not comply with the section cited above as one (1) out of two (2) facility bathroom faucet delivers hot water measured above 120 degrees Fahrenheit, which poses an immediate health and safety risk to persons in care.
	POC Due Date: 12/10/2022
	Plan of Correction
1 2 3 4	The Administrator adjusted the water temperature at the time of visit. Plan of Correction has been met.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2022

LIC809 (FAS) - (06/04)

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