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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336413251
Report Date: 08/01/2022
Date Signed: 08/01/2022 11:39:22 AM

Document Has Been Signed on 08/01/2022 11:39 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:HAPPY NEST IIFACILITY NUMBER:
336413251
ADMINISTRATOR:CLAIRE ITCHONFACILITY TYPE:
740
ADDRESS:3180 E. VISTA CHINOTELEPHONE:
(760) 992-9645
CITY:PALM SPRINGSSTATE: CAZIP CODE:
92262
CAPACITY: 6CENSUS: 6DATE:
08/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:George Camua & Claire Itchon - AdministratorsTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of completing the facility's Annual Inspection. LPA Colvin met with Staff Myrna Lomboy and advised of the purpose of the visit, and that the Annual Inspection will be limited to Infection Control only. Administrators Claire Itchon & George Camua arrived prior to the conclusion of the inspection and provided additional assistance and information. Below is a summary of what was observed:

Infection Control: LPA Colvin went over COVID-19 best practices for infection control and prevention with Administrator George Camua & Claire Itchon, who LPA Colvin found to be successfully incorporating the several aspects of the facility's Mitigation Plan. Residents have hand sanitizer available to them, and the bathrooms were stocked with hand soap and paper towels. While touring the facility, LPA Colvin observed postings throughout the facility for cough etiquette, social distancing, and infection control. LPA Colvin requested to view the facility's PPE supplies (gloves, masks, and sanitizer, and isolation gowns) which LPA Colvin observed to be sufficient for a 30-day supply and is accessible to staff. LPA Colvin went over the various recommended training for facility staff in relation to COVID-19 and confirmed that staff have been trained on various aspects of infection control, recognition of symptoms of COVID-19, and donning/doffing PPE.

LPA Colvin inquired as to if staff have been fit tested for N95 masks, and Administrator George Camua stated that they have not conducted fit testing for staff, as the facility uses KN95 masks. LPA Colvin will be issuing a Technical Assistance Advisory Note during today's inspection for staff not being fit tested for N95 masks. LPA Colvin will not be issuing a deficiency for this item due to the facility not currently having any COVID-19 positive residents, and N95 masks only needing to be worn when a resident is COVID-19 positive or under observation while awaiting test results. Administrators confirmed that both staff and visitors are screened for COVID-19 symptoms prior to entering the facility. LPA Colvin confirmed this as LPA Colvin's temperature was taken upon entry to the facility, and LPA Colvin signed in on the visitor log & temperature was recorded.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2022
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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: HAPPY NEST II
FACILITY NUMBER: 336413251
VISIT DATE: 08/01/2022
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Additionally, LPA Colvin observed several staff present to not be wearing any type of face covering when LPA Colvin initially entered the facility (including Administrator Geroge Camua when he arrived). At this time, face coverings are still required in all residential facilities. LPA Colvin will be issuing a TA Advisory Note staff not wearing a face covering.

Other:

When walking up to the facility, LPA Colvin observed large pieces of wood and metal from what appeared to be discarded furniture pieces on the front yard of the facility. Items were stacked haphazardly and not disposed of properly in a garbage bin, and pose a potential health and safety risk to residents and visitors. Administrator informed LPA Colvin that they were having someone come pickup the remaining items (shutters for windows). LPA Colvin informed the Administrators that if they could have the items removed from the facility grounds prior to LPA Colvin's completion of the Annual Inspection at the facility's other facility six houses down (#336424160), that LPA Colvin would not cite a deficiency. Administrators were able to coordinate removal of the items while LPA Colvin was conducting Annual Inspection at the Licensee's other facility. Since the violation was not an immediate health/safety risk and Administrators were able to correct the violation while LPA Colvin was in the vicinity, no deficiency was cited.

An exit interview was conducted with Administrators George Camua and Claire Itchon and a copy of this report and LIC9102-TA Advisory Notes was provided.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2022
LIC809 (FAS) - (06/04)
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