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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 561703785
Report Date: 07/06/2022
Date Signed: 07/06/2022 04:44:09 PM

Document Has Been Signed on 07/06/2022 04:44 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:LAIGO-ZANDERS HOME FOR THE ELDERLY IIFACILITY NUMBER:
561703785
ADMINISTRATOR:NORMA L. ZANDERSFACILITY TYPE:
740
ADDRESS:3190 E. ELMORE STREETTELEPHONE:
(805) 527-3007
CITY:SIMI VALLEYSTATE: CAZIP CODE:
93063
CAPACITY: 6CENSUS: 6DATE:
07/06/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:07 PM
MET WITH:Federico Borja Ladio & Annabelle Laigo-RamosTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Zabel Chochian arrived at the facility unannounced to conduct a required annual visit today. LPA was greeted by staff and reason for visit was explained. Staff contacted Administrator Norma Zanders. LPA spoke with Mrs. Zanders and reason for visit was explained.

This annual visit had a specific emphasis on infection control practices and procedures.



INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator via telephone regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and a sanitation station.

The LPA and staff toured the physical plant areas at approximately 1:15pm:

KITCHEN: Knives are stored in a locked cabinet in the kitchen. The facility has a 7 day supply of non-perishable and 2 day perishable food supply,

BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.

RESTROOMS: Resident restroom observed stocked with hygiene supplies, toilet paper and paper towel. Hand washing signs observed posted in the restroom.

COMMON LIVING AREA: Observed furnished accordingly for clients/visitors use.

OUTDOOR SPACE: The backyard was found to be clear of hazards.

Facility observed incompliance during todays visit.


Exit interview conducted with Annabelle Laigo-Ramos. Copy of report emailed to Administrator.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2022
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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