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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603599
Report Date: 09/03/2024
Date Signed: 09/03/2024 03:01:36 PM

Document Has Been Signed on 09/03/2024 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
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:BEST ELDER CAREFACILITY NUMBER:
197603599
ADMINISTRATOR/
DIRECTOR:		IGID, FABIOLAFACILITY TYPE:
740
ADDRESS:37620 SIMI STREETTELEPHONE:
(661) 878-8105
CITY:PALMDALESTATE: CAZIP CODE:
93552
CAPACITY: 6CENSUS: 5DATE:
09/03/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Gemma WanawanTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Evelin Rios and Angelica Segovia arrived at the facility. LPAs conducted a case management - deficiencies visit in conjunction to complaint control #31-AS-20240826142332. LPA Rios spoke to the administrator Fabiloa Igid via telephone and LPA explained the reason for the visit. The administrator informed LPAs that she is not available to meet them at the facility but would be available via telephone. The administrator designated staff, Gemma to sign today's report.

LPA's observed two (2) staff in the facility with two (2) residents. LPA's review of Guardian revealed both staff present were not associated to the facility. LPA requested staff records which revealed they did not have a clearance letter or transfers request for this facility. LPA asked S1 and S2 when they started working at the facility and both stated June 18, 2024. LPA contacted the administrator, Fabiola Igid and asked about the two (2) staff present. The administrator informed LPA she believed she sent out a request to associate them to the Regional Office (RO) via email. The administrator called LPA later and informed LPA Rios they could not find the email sent to RO and they may have forgotten to send it. LPA review of Guardian found both staff are background cleared and not associated to this facility. Administrator stated they will be at the facility today.

Deficiency cited. Appeals right provided. Copy of report provided.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE: DATE: 09/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/03/2024
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 09/03/2024 03:01 PM - It Cannot Be Edited


Created By: Evelin Rios On 09/03/2024 at 02:12 PM
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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: BEST ELDER CARE
FACILITY NUMBER: 197603599

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/04/2024
Section Cited
CCR
87355(e)(2)

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e) All individuals subject to a criminal record review...shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or... This requirement is not met as evidenced by:
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The administrator will remove staff #1 (S1) and Staff #2 (S2) and not allow them to return to the facility until association or requested transfer is complete. The adminsitrator will submit an updated LIC500 and a screen grap of the facility roster on Guardian by POC due date 09/04/2024.
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Based on interviews and record review, the licensee did not comply with the section cited above as the facility did request a transfer of a criminal record clearances for two(2) staff which poses an immediate Health, Safety or Personal Rights risk to residents in care.
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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:Eva Miller
LICENSING EVALUATOR NAME:Evelin Rios
LICENSING EVALUATOR SIGNATURE:
DATE: 09/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/03/2024


LIC809 (FAS) - (06/04)
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