<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602994
Report Date: 05/21/2021
Date Signed: 07/23/2021 08:38:44 AM

Document Has Been Signed on 07/23/2021 08:38 AM - 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:QFC LOVING CARE INC (SANTANA)FACILITY NUMBER:
198602994
ADMINISTRATOR:ABESHYAN, HELENFACILITY TYPE:
740
ADDRESS:18311 SANTANA AVETELEPHONE:
(818) 599-3115
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY: 6CENSUS: 4DATE:
05/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:12 AM
MET WITH:Helen AbeshyanTIME COMPLETED:
03:15 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) Nicol Wesley conducted a Required 1 year inspection at the facility and met with Licensee Helen Abeshyan and explained the purpose for todays visit. Prior to the visit LPA Wesley conducted a risk assessment for on-site inspections. The facility has an approved mitigation plan. The facility phone number is 562 219 0110.

During the visit the Infection control domain was used and the following areas were observed/inspected: The facility had all postings at the front entrance, bathrooms, and throughout the facility. Hand sanitizing gel and masks were located at the entry of each room. A Pre screening area with PPE supplies was observed upon entry into the facility. Surveillance testing is conducted weekly. The last test was conducted on 05/17/21 and the results were negative for staff and residents.

LPA Wesley conducted a complete tour of the facility, and observe the supply of food. Resident medications, medication logs, randomly selected staff and resident files were reviewed. The smoke detectors/carbon monoxide detector are operable. LPA observed two fully charged fire extinguishers in the kitchen and hallway. The water temperature was tested and measured 107.2 degrees F.

Administrators certificate for Helen Abeshyan #6044818740, expires on 05/15/21(the licensee has renewed and is waiting on new certificate) .

There were no deficiencies cited.

Exit interview conducted.
SUPERVISORS NAME: Rebecca Orendain
LICENSING EVALUATOR NAME: Nicol Wesley
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2021
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 1