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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405850500
Report Date: 07/22/2024
Date Signed: 07/23/2024 08:09:31 AM

Document Has Been Signed on 07/23/2024 08:09 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:CARING HANDS HOME CAREFACILITY NUMBER:
405850500
ADMINISTRATOR/
DIRECTOR:		LOSBOG, ARLENE RAMOSFACILITY TYPE:
740
ADDRESS:801 ST. ANDREWS CIRCLETELEPHONE:
(805) 221-5644
CITY:PASO ROBLESSTATE: CAZIP CODE:
93446
CAPACITY: 6CENSUS: 0DATE:
07/22/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:36 AM
MET WITH:Licensee, Arlene LosbogTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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 At 11:18am on 07/22/2024, Licensing Program Analyst (LPA) Jeffries arrived at the scheduled time to conduct the facility pre licensing inspection. LPA met with Licensee Arlene Losbog and Care Giver Eric Bunte (S1). LPA announced who he is and the reason for the visit.
This facility is a 4 bedroom, 2 bathroom, with kitchen, dining room, living room, laundry room, and 3 car garage. There is a large back yard with seating and covered patio for shade. Bedrooms 1-3 are designated for double resident occupancy, and residents share bathroom 1. Bedroom 4 is designated for staff use and has an on suite bathroom. Medications, first aide kit and staff and resident files are located in a locked cabinet in the dining room area. LPA noted that all chemicals and hazardous materials are located in the garage and laundry room behind locked doors. LPA noted that there is a refrigerator in the garage as well as the kitchen that are operating normally. LPA noted that all appliances in kitchen and bathroom are operating normally. All tested for function by LPA at time of facility physical tour. LPA noted that the facility bathrooms are stocked and meet regulation requirements regarding infection control standard practices. LPA noted that the facility has ample linin for 6 resident and staff. LPA noted that there is a large supply of Personal Protective Equipment (PPE) stored in the garage and incontinence supply in the hallway closet. LPA tested facilities smoke detector and carbon monoxide detectors to be functioning properly. LPA observed two fire extinguishers to be primed in the green range indicating primed to function. LPA noted that the facility was clean and in good repair. LPA noted that facility required posting were posted in the facility hallway and the facility has been instructed to contact the local Ombudsmen's Office to obtain Ombudsmen's poster.
Licensee, S1 and LPA conducted the Component III orientation and a full review of the Pre Licensing Care Tools module. LPA noted a screen needed to be repaired on the front living room window. LPA noted that the Emergency Disaster Plan and Infection Control plan both meet regulation requirements. LPA noted that dementia care is address as a separate packet to the Plan of Operations.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2024
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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: CARING HANDS HOME CARE
FACILITY NUMBER: 405850500
VISIT DATE: 07/22/2024
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LPA noted that all Pre Licensing documentation has been reviewed. Licensee agreed to have screen fixed by 07/23/2024 and send proof to LPA by end of day 07/23/2024. LPA noted that the facilities could not present proof of current liability insurance Licensee with forward the liability policy when they have possession of the liability insurance contract.


Comp III orientation provided, exit interview, report read, and report provided.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024
LIC809 (FAS) - (06/04)
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