565850260-10-12-2023-29-AS-KDUK-CWJR6D-20231012124433

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565850260
Report Date: 10/12/2023
Date Signed: 10/12/2023 12:44:40 PM

Document Has Been Signed on 10/12/2023 12:44 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:	BEST OF CARE HOMES, INC.		FACILITY NUMBER:	565850260
ADMINISTRATOR:	ARCENAS, OSKAR KYLE		FACILITY TYPE:	735
ADDRESS:	1742 EUCLID AVENUE		TELEPHONE:	(805) 758-3474
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93010
CAPACITY: 4		CENSUS: 4	DATE:	10/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Oskar Kyle Arcenas		TIME COMPLETED:	12:50 PM

NARRATIVE

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Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct an annual visit. LPA, along with Tri-Counties Regional Center Quality Assurance Specialist (QA) Liz Aced-Arnett arrived at 09:40AM and initially met with facility staff. Administrator was contacted and arrived at the facility at approximately 10:10AM. Entrance interview conducted.

Beginning at 09:45AM, the LPA, QA, along with facility staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

The facility is vendored through Tri-Counties Regional Center as a Level 3 home. Fire extinguishers are fully charged and last serviced on 07/15/2023. Hardwired combination smoke detectors were tested at 11:46AM and were functional at the time of the visit. No fire clearance concerns were observed.

Bedrooms: There are 4 total bedrooms in the facility. All 4 are private client bedrooms. All 4 client bedrooms were observed and appeared clean, with appropriate linens and furnishings.

Bathrooms: LPA observed all 2 and 1/2 bathrooms were clean, properly supplied and had functional fixtures. LPA observed all bathrooms to have non-skid mats. Clients have sufficient amounts of supplies for personal hygiene. At 09:48AM, Clorox disinfecting wipes and Clean Shower were observed in an unlocked cabinet under the sink in the private restroom for Room #2. Water temperature was measured in client restrooms and measured within the required range.

Common Areas: These included the dining area and living room. The common areas were checked for cleanliness good condition. At the time of the visit, walls, flooring, and furniture were observed to be in good

Report Continued on LIC 809-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

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 10/12/2023 12:44 PM - It Cannot Be Edited

Created By: Kelly Dulek On 10/12/2023 at 11:53 AM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: BEST OF CARE HOMES, INC.	FACILITY NUMBER: 565850260
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/12/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80087(g)

Building and Grounds

(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients. 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 cleaning supplies and chemicals were observed to be unlocked under a client's private bathroom sink, under the kitchen sink, in a cabinet which was left unlocked in the laundry room, and cleaning supplies and a knife were observed in the garage which poses an immediate health and safety risk to persons in care.
	POC Due Date: 10/20/2023
	Plan of Correction
1 2 3 4	Administrator secured all items during today's visit. Administrator agreed to provide training to all staff on accessible items and provide proof to CCL by POC due date.

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:

Kristin Heffernan

LICENSING EVALUATOR NAME:

Kelly Dulek

LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

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: BEST OF CARE HOMES, INC.	FACILITY NUMBER: 565850260
	VISIT DATE: 10/12/2023

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condition. A fireplace, which was properly screened, was observed in the living room. There is a laundry room available for client use. At 09:56AM, the laundry room cabinet was observed unlocked and accessible to clients, which contained Clorox Disinfecting Mist, Shower Brite, Clorox Fraganzia, Lysol Disinfecting Spray and Comet Cleanser.

Surrounding Grounds (Outdoors): There was a shaded area with proper furniture for outdoor use. There are no bodies of water on the premises. Three (3) outdoor sheds were observed to be locked.

Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient amount of perishable and non-perishable food at the facility; properly stored. At 09:57AM, cleaning supplies were observed under the kitchen sink in a latched, but unlocked cabinet. Knives and sharp objects are stored locked.

Garage: Garage was observed unlocked and contained extra food, staff area, and storage. At 10:02AM, powdered laundry detergent was observed in the unlocked and open garage, accessible to clients in care.

Record Review/Medication Review: Record review began at 10:25AM. Staff and client records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, client physician's report, needs and service appraisal, and personal rights. Five (5) staff files and all four (4) client files observed were in compliance with regulation. Cash resources for two (2) clients were reviewed and observed to be accurate and properly documented. Medication review began at 11:37AM. Medications for all four (4) clients were observed. All medications observed were labeled, stored, and properly documented at the time of the visit.

Infection Control/Emergency Disaster Planning: During today’s visit, the LPA reviewed the facility's infection control practices and emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency drills are conducted quarterly, with the last drill conducted on 08/24/2023. Emergency disaster plan was observed to be complete and updated annually, as required.

Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiency was cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties.

Exit interview conducted, appeal rights discussed. A copy of this report and appeal rights were provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

LIC809 (FAS) - (06/04)

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