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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203358
Report Date: 01/26/2023
Date Signed: 01/31/2023 10:13:45 AM

Document Has Been Signed on 01/31/2023 10:13 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, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:POSITIVE DIRECTIONS #9FACILITY NUMBER:
157203358
ADMINISTRATOR:HOBBS, ANNFACILITY TYPE:
740
ADDRESS:329 EL CAMINO DRIVETELEPHONE:
(661) 721-3525
CITY:DELANOSTATE: CAZIP CODE:
93215
CAPACITY: 4CENSUS: 3DATE:
01/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Trisha LaGue, CEOTIME COMPLETED:
05:30 PM
NARRATIVE
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On 01/26/23, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct a Case Management visit. LPA was greeted by staff, stated the purpose of the visit and was allowed entry into the facility. COVID precautionary measures were taken at the time of entry.

LPA is following up on a letter received 01/04/23 from the licensee. Letter was requesting an exception to retain Resident R1 from the hospital with a Prohibited Condition. Records review show R1 was admitted to the hospital with a diagnosis of a prohibited condition. R1 has not returned to facility and is currently residing in a Skilled Nursing Facility (SNF).

LPA reviewed additional facility records received at a previous visit and observed Staff S2 had been working in the facility for more than 5 days, without a Criminal Background Check/ fingerprint clearance. Staff S2 was removed from the facility schedule until a fingerprint clearance was obtained.

Based on the information received, deficiencies are being cited, per California Code of Regulations, Title 22, Division 6, Chapter 8, on the attached 809D. Immediate Civil Penalties are being assessed on the attached LIC421IM and the LIC421BG in the amount of $500, for each violation, for a total of $1000: If not corrected, the violation will have a direct and immediate risk to the health, safety, or personal rights of resident's in care.

An exit interview was conducted with Licensee via telephone. A plan of correction was developed by licensee and reviewed with LPA via telephone. Licensee gave permission for Staff S1 (S1) to sign today's report. A copy of this report and appeal rights were discussed and provided to S1.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2023
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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Document Has Been Signed on 01/31/2023 10:14 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 01/30/2023 10:44 AM


Created By: Lisa Salazar On 01/26/2023 at 09:38 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: POSITIVE DIRECTIONS #9
FACILITY NUMBER: 157203358

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/27/2023
Section Cited
CCR
87615(a)(4)

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Prohibited Health Conditions (a)Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly (4) Staphylococcus aureus ("staph") infection or other serious infection.:
This requirement was not met as evidenced by LPA's observation of records and interviews with staff, R1 was admitted to the hospital from the facility with severe sepsis.
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Licensee will review the regulation LPA provided, conduct a staff training on recognizing and identifying Title 22 Prohibited Conditions. Licensee will send the signed copies from all staff, acknowledging they understand the regulation by POC date of 01/27/23.
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LPA's observation of records and interviews with Staff, R1 was admitted to the hospital from the facility with severe sepsis. If not corrected, the violation will have a direct and immediate risk to the health, safety, or personal rights of resident's in care.** A Civil penalty in the amount of $500 is hereby assessed**
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Type A
01/27/2023
Section Cited
CCR87355(e)(1)

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87355 Criminal Record Clearance(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by:
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S2 was immediately removed from the schedule and will not return to work without the required clearance and association. L1 will have S2 fingerprint cleared and submit required documentation by POC date of 01/27/23.
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LPA's observation of staff schedule and interviews with licensee, Staff S2 has not received a fingerprint clearance and has been working in the facility since 08/2022. If not corrected, the violation will have a direct and immediate risk to the health, safety, or personal rights of resident's in care ** A Civil penalty in the amount of $500 is hereby assessed**
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Melinda Hoffmann
LICENSING EVALUATOR NAME:Lisa Salazar
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/31/2023 10:15 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 01/30/2023 09:29 AM


Created By: Lisa Salazar On 01/26/2023 at 10:08 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: POSITIVE DIRECTIONS #9
FACILITY NUMBER: 157203358

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/30/2023
Section Cited
CCR
87211(a)(1)(B)

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No Deficiency cited. Form created in error. Facility reported incidents as required by Title 22.
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N/A
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CCR

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Melinda Hoffmann
LICENSING EVALUATOR NAME:Lisa Salazar
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023


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, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: POSITIVE DIRECTIONS #9
FACILITY NUMBER: 157203358
VISIT DATE: 01/26/2023
NARRATIVE
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This report was generated in error.

Page left blank intentionally
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
LIC809 (FAS) - (06/04)
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