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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801730
Report Date: 02/06/2023
Date Signed: 02/06/2023 03:31:21 PM

Document Has Been Signed on 02/06/2023 03:31 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:FINEST LIVING AT ARCADEFACILITY NUMBER:
565801730
ADMINISTRATOR:GARNER J. CRUZFACILITY TYPE:
740
ADDRESS:350 SOUTH ARCADE DRIVETELEPHONE:
(805) 628-9181
CITY:VENTURASTATE: CAZIP CODE:
93003
CAPACITY: 6CENSUS: 5DATE:
02/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:27 AM
MET WITH:Marlene Santos / Care GiverTIME COMPLETED:
02:55 PM
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 At 10:28am on 02/06/2023, Licensing Program Analyst (LPA) Jeffries arrived unannounced at the facility. LPA was greeted at the door by Marlene Santos (S1) who asked LPA to sign-in to entrance log but did not screen LPA for any infection control protocols. LPA also noted that both care givers present were not wearing masks and were then were requested by LPA to put on masks unless they have a medical or religious waver. LPA requested S1 call Administrator. At 11:45am, LPA received a call from Adelaida Cruz (S3), who was identified by S1 as being the current administrator.
LPA conducted the infection control module of the annual inspection with S1. The following technical Assistance were cited:
(1) Section 102: Screening, there was no infection control screening up entrance to the facility during this annual inspection visit;

(2) Second 109; face covering. S1 and S2 were not wearing face coverings when LPA arrived and S2 did not put on face covering until LPA asked S2 a third time to put on face coverings 44 minutes into the annual visit. Section 112; There was no screening or request to sanitize or wash hands when LPA entered the facility. LPA was asked to singe in log book but no screening took place;

(3) Section 126, there are no trash bins with lids for positive isolated resident infection control practices, additionally there is not enough PPE supplies at the facility to stage a positive resident room infection control cart.;

(4) Section 142, Staff could did not provide Provider Information Notices (PINs) upon request of LPA. Section 152: Number #2 bathroom did not have any liquid soap or other soap.; Section 153, Personal Protective Equipment (PPE) shown to LPA at request was limited to 40 gowns, partial box of N95 masks, there were no gloves or eye protection observed by LPA upon request.
CONTINUED on LIC809-C
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE: DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2023
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: FINEST LIVING AT ARCADE
FACILITY NUMBER: 565801730
VISIT DATE: 02/06/2023
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LPA and S1 conducted a cursory walk through tour of the facility. LPA noted that a cursory tour of the facility did not yield any citations, at this time. LPA provided a list of correction noted from infection control module on the technical assistance (TA) violations noted needed to rectify those technical assistance issues present. LPA will follow up by phone on March 7, when S3 returns from overseas to check on the TAs. S1 and S3 will send pictures of items listed on those TA's that were addressed and fixed. No other violations or citation were issued on this annual visit.

Exit interview, report read, and report signed.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023
LIC809 (FAS) - (06/04)
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