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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003816
Report Date: 11/18/2021
Date Signed: 11/18/2021 11:12:38 AM

Document Has Been Signed on 11/18/2021 11:12 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:SWEETEST HOMES 4 SENIORS IIFACILITY NUMBER:
306003816
ADMINISTRATOR:YVONNE ISACKSONFACILITY TYPE:
740
ADDRESS:2812 TIGERTAIL DRIVETELEPHONE:
(562) 430-6500
CITY:ROSSMOORSTATE: CAZIP CODE:
90720
CAPACITY: 6CENSUS: 2DATE:
11/18/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Yvonne IsacksonTIME COMPLETED:
11:30 AM
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Licensing Program Analysts (LPAs) Joseph Alejandre and Shobhana Frank made an unannounced visit to conduct a Technical Assistance visit (Covid-19 mitigation) to assist the facility with Covid-19 mitigation procedures. LPAs were greeted and granted entry by Licensee/Administrator Yvonne Isackson. LPAs explained the reason for the visit. LPAs utilized the inspection tool infection control domain to assess the facility's Covid-19 mitigation plan/procedures. LPAs explained the process to Licensee, who stated she understood. LPAs and Licensee toured the facility. LPAs observed all resident bedrooms had the required furnishings. All resident bedrooms were large enough to accommodate the residents and their belongs. All bathrooms were clean and operational. LPAs observed and the Licensee verified there are 3 entrance/exit points to the facility, front door, back door and a side door. LPAs observed there is no sign in sheet and LPAs were not screened for symptoms of Covid-19 and their temperatures were not checked prior to entering the facility. LPAs and Licensee toured the kitchen. Facility has a 2 day perishable and 7 day non-perishable food supply on hand. LPAs observed the medication is kept locked in kitchen cabinets. LPAs observed the fireplace in the living room and the fireplace in the family room (which has a TV for residents) are screened. LPAs did not observe any Covid-19 signs in the facility. Licensee requested Covid-19 signs from LPAs. Agency will provide Licensee with Covid-19 signs. LPAs and Licensee toured the backyard. No bodies of water observed. The shed in the backyard is kept locked and used for storage. Both exit gates are operational. The garage can only be accessed from outside of the house. LPAs observed the garage is not locked and used for storage of tools and chemicals. LPAs observed brick tiles stacked by the exit gate. Smoke detectors tested operational. Facility has a mitigation plan that has been approved. No deficiencies are being cited as a result of today's visit. Licensee provided with Technical Assistance notes concerning Covid-19 mitigation requirements. An exit interview was conducted and a copy of the report was provided.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2021
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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