197604989-2-11-2022-31-AS-APAA-CBJSQ7-20220211130417

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197604989
Report Date: 02/11/2022
Date Signed: 02/11/2022 01:05:13 PM

Document Has Been Signed on 02/11/2022 01:05 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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	DURANDO HOME II		FACILITY NUMBER:	197604989
ADMINISTRATOR:	JAMES DURANDO		FACILITY TYPE:	740
ADDRESS:	38757 37TH STREET EAST		TELEPHONE:	(661) 266-0551
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93552
CAPACITY: 4		CENSUS: 4	DATE:	02/11/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	James Durando, Administrator		TIME COMPLETED:	01:25 PM

NARRATIVE

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At 10:00am Licensing Program Analyst (LPA) Angela Panushkina, conducted an unannounced annual inspection at the above facility. LPA met with the Staff #1, who granted access to home. Administrator arrived shortly after and LPA explained the reason for the visit.

LPA toured the entire facility with the Administrator, and observed the following:

This is a 5 bedroom, 2 bathroom, single story family residence that includes a living room, dining area, kitchen, laundry room and attached garage.

Infection control: Upon arrival LPA did not observe a screening area, was not screened by S #1 and was not asked any infection control questions. The screening log was not available and LPA had to prompt and guide staff through the screening process. Administrator stated they have sufficient PPE supplies for residents and staff.

Kitchen: At approximately, 10:34am LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents.
Smoke detectors/carbon monoxide. Dual smoke and carbon monoxide detectors were located throughout the facility, and at 11:05am they were tested and observed to be operational.

Bedrooms: There are four (4) bedrooms designated for residents use and have sufficient lighting. All bedrooms are properly furnished, clean and have appropriate bedding and linens.

Bathrooms: At 10:50am LPA observed all bathrooms are clean and in good repair. The hot water temperature Continue on LIC809-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022

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., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: DURANDO HOME II	FACILITY NUMBER: 197604989
	VISIT DATE: 02/11/2022

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measured at 105°F. LPA observed appropriate grab bar and non-skid mat. LPA observed appropriate hand washing signs posted in each bathroom. All trash cans in bathrooms had fitted lids to protect from cross contamination.

Common Areas: The facility maintains a comfortable temperature at 71°F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. There is a fire extinguisher by the kitchen and it was last serviced on 04/15//21. Laundry area was located in a hallway and all chemicals observed to be locked and inaccessible to residents.

Outside areas: At approximately, 11:00am LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents. There are no bodies of water.

The garage: LPA observed attached garage that is used for storage and kept locked and inaccessible to residents.

Medications: At approximately, 10:50am LPA observed medications are centrally stored and locked in the cabinet, by the dining area and inaccessible to residents in care.

Administrative: Administrator will email a copy of Liability Insurance and LIC.500.

Deficiencies issued per Title 22.

Appeal rights issued.

Exit interview conducted. Copy of this report emailed to Licensee.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/11/2022 01:05 PM - It Cannot Be Edited

Created By: Angela Panushkina On 02/11/2022 at 12:47 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: DURANDO HOME II	FACILITY NUMBER: 197604989
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/11/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87468.1(a)(2)

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. 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. The licensee failed to follow the infection control protocol on screening procedures. Staff was not familiar with screening procedures, thermometer was not operating properly and no symptom screening questions have been asked, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/13/2022
	Plan of Correction
1 2 3 4	Licensee agreed to train all staff on Mitigation Plan and infection Control which includes screening. Staff sign-in sheet and training materials shall be e-mailed to LPA by POC 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:

Nichelle Gillyard

LICENSING EVALUATOR NAME:

Angela Panushkina

LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2022

LIC809 (FAS) - (06/04)

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