565850107-2-17-2023-29-AS-MARO-CP5T7U-20230217132919

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565850107
Report Date: 02/17/2023
Date Signed: 02/17/2023 01:29:56 PM

Document Has Been Signed on 02/17/2023 01:29 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:	LOVIES BOARD AND CARE		FACILITY NUMBER:	565850107
ADMINISTRATOR:	BONOAN, SOPHIA		FACILITY TYPE:	740
ADDRESS:	3125 MICHAEL DRIVE		TELEPHONE:	(805) 407-1378
CITY:	NEWBURY PARK	STATE: CA	ZIP CODE:	91320
CAPACITY:	6	CENSUS: 5	DATE:	02/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Sophia Bonoan		TIME COMPLETED:	01:45 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 with focus on Infection Control. The last Annual conducted at this facility was on 03/24/2022. Upon arrival, the LPA was screened and greeted at the door by staff. The Administrator, Sophia Bonoan arrived shortly after and the reason for the visit was explained. Entrance Interview.

The LPA along with the Administrator began the physical plant tour of the common areas, kitchen area, resident bedrooms, bathrooms, garage, and outdoor area to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.

The LPA observed two (2) resident bathrooms. Hot water is in compliance between 105- and 120-degrees Fahrenheit. The LPA observed an adequate amount of perishable and non-perishable food. LPA observed fire extinguisher was newly purchased on 02/04/2023. At 12:36 pm, the smoke detectors and carbon monoxide detectors were tested and operable. LPA observed medications locked in the closet by the main hallway. Sharps and knives were observed locked under the kitchen sink. LPA observed Emergency food and water supply. The living areas and dining areas are clean and properly furnished. LPA observed two (2) residents in the dining room having lunch at the time of the visit. LPA observed outdoor grounds with clear passageways and one (1) self-latching gate clear of obstruction for emergency use. No bodies of water observed 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: 02/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 2

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: LOVIES BOARD AND CARE	FACILITY NUMBER: 565850107
	VISIT DATE: 02/17/2023

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
26
27
28
29
30
31
32

Report Continued from LIC 809 ...

During today's visit, the LPAs 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. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVlD-19. All staff are fully vaccinated. The LPA observed staff wearing face coverings at the time of visit. No identified staffing concerns.

Exit interview conducted. No citations issued. Report was reviewed and issued to Administrator.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023

LIC809 (FAS) - (06/04)

Page: 2 of 2