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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 585002753
Report Date: 05/16/2022
Date Signed: 05/16/2022 12:09:16 PM

Document Has Been Signed on 05/16/2022 12:09 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:AGUIRRE CARE HOMEFACILITY NUMBER:
585002753
ADMINISTRATOR:AGUIRRE, LEAHFACILITY TYPE:
735
ADDRESS:966 SUGARSTICK DRIVETELEPHONE:
(858) 717-6817
CITY:PLUMAS LAKESTATE: CAZIP CODE:
95961
CAPACITY: 4CENSUS: 4DATE:
05/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Leah Aguirre, Licensee/AdministratorTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPAs) Mai Thao and Talwinder Bains arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the infection control domain on today's date. LPAs met with Leah Aguirre, Licensee/Administrator. LPAs explained the purpose of the visit. Prior to initiating the annual inspection, LPAs completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPAs ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 In addition, Staff screened LPA prior to entering the facility.

During the inspection, 4 clients were present at the facility with 1 staff member. Areas toured include but are not limited to: common area, 4 client bedroom, 2 bathroom, 1 staff bedroom, 1 private staff bathroom, laundry room, garage, kitchen, and storage areas. In the areas toured no immediate health, safety, or personal rights violations were observed. LPAs and Licensee completed the infection control domain and facility was found to be in substantial compliance at this time.

Facility was advised to keep 30 days supplies of PPE available at the facility. LPAs did not observe any N95 mask at the facility and advised facility to keep a 30 days supply. Licensee stated that Licensee is working on getting staff fit-tested for N95. LPAs reviewed 4 of 4 clients Centrally Stored Medications. All medications has physician's order on file and were all logged on Centrally Stored Medication Logs. LPA reviewed 4 of 4 clients P&I Money. P&I were locked and not kept with facility money. Facility has 7 days of non-perishable and 2 days of perishable food supply on today's date to meet the dietary needs of 4 clients in care. LPAs reviewed 3 of 3 staff files.

During the inspection, LPAs and Licensee discussed the facility's infection control and mitigation plan.
No deficiencies are being cited as a result of today’s inspection. Exit interview conducted and copy of this report was left at the facility.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Mai Thao
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2022
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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