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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880919
Report Date: 07/20/2021
Date Signed: 07/20/2021 10:49:12 AM

Document Has Been Signed on 07/20/2021 10:49 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:LOVE 2 CARE HOMESFACILITY NUMBER:
361880919
ADMINISTRATOR:JACKSON, TERRIFACILITY TYPE:
740
ADDRESS:19432 US HIGHWAY 18TELEPHONE:
(760) 297-6277
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY: 6CENSUS: 3DATE:
07/20/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Eula JonesTIME COMPLETED:
10:58 AM
NARRATIVE
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Licensing Program Analyst's (LPAs) Anna Bueno and Natalie Gayoso made an unannounced visit to the facility. The purpose of the visit was to conduct a required annual inspection, with an emphasis on infection control due to the COVID-19 pandemic. LPAs Gayoso and Bueno met with caregiver Eula Jones, who confirmed that there are currently no cases/exposures of COVID-19 within the facility. Administrator Terri Jackson was notified of the inspection by phone.

During the inspection, LPAs Bueno and Gayoso conducted a brief tour of the facility and made observations pertaining to the facility's infection control measures. LPAs observed that all staff members were properly fitted with face coverings and there are sufficient hand sanitizers. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the proper use and disposal of PPE. The facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolating/quarantining residents, and properly caring for residents with COVID-19 positive results and/or exposures. The facility also has a plan in place to monitor residents regularly for any changes in condition and to subsequently notify the resident's physician and emergency personnel in the event the client presents any COVID-19 symptoms.

LPA Gayoso and Bueno observed no health and safety concerns at the time of visit. Based on observations made during today’s inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. A technical advisory was given to ensure sufficient PPE is maintained at the facility. An exit interview was conducted where this report was discussed and a copy of this report was also provided to Jones at the conclusion of the inspection.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2021
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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