374604803-6-21-2024-08-AS-MGCO-D6FS6J-20240621133559

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604803
Report Date: 06/21/2024
Date Signed: 06/21/2024 01:38:09 PM

Document Has Been Signed on 06/21/2024 01:38 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	WARM HEART SENIOR LIVING		FACILITY NUMBER:	374604803
ADMINISTRATOR/ DIRECTOR:	REMOT, DHANA		FACILITY TYPE:	740
ADDRESS:	4419 ALLEN SCHOOL LANE		TELEPHONE:	(619) 733-7819
CITY:	BONITA	STATE: CA	ZIP CODE:	91902
CAPACITY: 6		CENSUS: 0	DATE:	06/21/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:31 AM
MET WITH:	Applicant, Dhana Remot		TIME VISIT/ INSPECTION COMPLETED:	12:45 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’s (LPA) Marisela Garcia-Centeno conducted an announced Pre-Licensing with the Component III inspection, and to observe the facility’s physical plant for complaint with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted at the front entrance by the Administrator, Dhana Remot and was granted entry after identifying herself and disclosing the purpose of their visit. The three (3) owners of the property, Ferdinand, Florino, and Corazon Agpaoa were present during the inspections. The fire clearance was approved on 5/7/2024 and reflected that the facility was approved for six (6) residents for Residential Care Facility for the Elderly (RCFE), all of whom may be non-ambulatory, of which one (1) may be bedridden. As of today's visit, there were no residents in care. The submitted facility sketch was consistent with the current layout of the facility. During today’s visit, LPA accompanied by Administrator Dhana Remot, conducted an overall inspection of the internal and external areas of the facility. There are five (5) bedrooms and three (3) bathrooms for residents to use. One (1) room is double occupancy, and one (1) room is designated as a bedridden (room #4). The facility has all the required furnishings, linens, and personal hygiene items. Bathrooms are equipped with grab bars and non-skid mats or stickers. The facility was clean, sanitary, and in good repair. Resident bedrooms allowed for easy passage with no obstruction and contained the required furnishings. Toilets, sinks, and showers were in working order. Each window had a screen which was in good condition. The facility’s ambient internal temperature was compliant at 74 degrees F. Hot water temperature at taps accessible to residents was also compliant: the bathroom sink was at 111 degrees and the kitchen sink was at 111.4 degrees. (continue at LIC809C

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: WARM HEART SENIOR LIVING	FACILITY NUMBER: 374604803
	VISIT DATE: 06/21/2024

NARRATIVE

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(Conitune from LIC809)

All outdoor and indoor pathways were free from obstruction and slip hazards. Fire extinguishers (2) were serviced within the last 12 months and affixed with current tags. Smoke and carbon monoxide detectors, emergency lighting, and facility telephone were present and operational.

The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and resident activities. The facility has no pools or bodies of water that were observed on the facility premises. Per applicants, no firearms or ammunition are or will be stored on the facility premises.

All toxic substances/poisons, and chemicals were stored in an inaccessible areas from residents. No fireplaces, and/or open-faced heaters were observed to be accessible to residents.

The facility has locked areas for storage of sharp objects. The facility kitchen was stocked with appropriate cooking items, and knives were locked in a secure cabinet which is inaccessible to residents. A seven (7) day non-perishable and two (2) day perishable food supply was present.

A designated storage lockable area for medications was observed to be available for use. Due to the layout of the facility, owners will consider obtaining a medication cart in order to have medications secured, locked, and inaccessible to residents. This will facilitate the administration of medications for residents in care. Three (3) first aid kits and a manual were present and readily available for use. A secured designated area for resident and staff files was also observed to be available in a locked cabinet. Required licensing postings were observed in visible areas of the facility.

LPA discussed continuing operation requirements, record keeping, reporting requirements and physical plant compliance with the applicant. The items reviewed were complaint with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code.

(continue at LIC809C)

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: WARM HEART SENIOR LIVING	FACILITY NUMBER: 374604803
	VISIT DATE: 06/21/2024

NARRATIVE

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(Continue from LIC809)

The Pre-Licensing and Component III inspection was completed during today’s visit. The applicant was advised that the facility is ready for licensure pending management's final review and approval.

An exit interview was conducted with Administrator, Dhana Remot, as well as the owners Agpaoa, to whom a copy of this report along with the licensee Appeal Rights (LIC 9058 01/16) was provided at the conclusion of the visit. The signature below confirms receipt of these documents.

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2024

LIC809 (FAS) - (06/04)

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