191222639-9-5-2023-29-AS-BBAI-CVDVBC-20230905161720

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 191222639
Report Date: 09/05/2023
Date Signed: 09/05/2023 04:18:44 PM

Document Has Been Signed on 09/05/2023 04:18 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:	ONEGENERATION - MARK TAPER J.O.Y. PROGRAM		FACILITY NUMBER:	191222639
ADMINISTRATOR:	ANNA SWIFT		FACILITY TYPE:	775
ADDRESS:	17400 VICTORY BLVD.		TELEPHONE:	(818) 708-6625
CITY:	VAN NUYS	STATE: CA	ZIP CODE:	91406
CAPACITY: 90		CENSUS: 8	DATE:	09/05/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Michelle Quiroga-Diaz - Director		TIME COMPLETED:	04:30 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 Analysts (LPA) Brian Balisi conducted an unannounced required annual visit. Upon arrival LPA met with Michelle Quiroga-Diaz - Director and explained the reason for the visit. The Adult day program is a part of the inter-generational program. The program includes an adult day program, health care and child care participants. The LPA, along with Quiroga-Diaz toured the physical plant areas inside and outside at approximately 01:10pm to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The rooms toured in the facility consisted of the waiting area, (2) Activity Rooms, Rehab area, Patio, program offices, Nurses station, Charting / records room, (2) bathrooms for clients use each, parking lot and community food pantry. At approx. 01:20pm, LPA observed clients participating in activities conducted in the (2) activity rooms. The LPA observed the required postings throughout the facility. Fire extinguishers were observed to be fully charged and last serviced on June 2023. Carbon / Fire detectors were also observed to be working at the time of visit. Emergency drills are conducted monthly, with the last emergency drill conducted in August of 2023 for an Earthquake emergency. Furniture in each activity room were observed to be in good repair. Other equipment used for activities appears to be in adequate condition at this time. Nurses station was observed to store medication, first aid, PPE and all were observed to be inaccessible to clients at this time. Public restrooms were observed to be clean and sanitary and in operating condition. The LPA observed sufficient amounts of soap and paper products in each restroom, as well as hand washing posters.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

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: ONEGENERATION - MARK TAPER J.O.Y. PROGRAM	FACILITY NUMBER: 191222639
	VISIT DATE: 09/05/2023

NARRATIVE

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Continued from 809

At approx. 1:30pm, Water temperature was measured in various restrooms throughout the facility and measured between 100.1 - 103.5 degrees Fahrenheit.
Storage area located in the rear of the men's restroom was observed to store cleaning supplies. This room was observed to be locked during the visit. Laundry room was located across the hall from women's restroom. Cleaning supplies and detergent were observed to be stored in this area and was inaccessible to clients during the visit.

Dining area/Kitchen: The dining/kitchen area appeared clean and sanitary; appliances and fixtures were observed to be functioning during the time of the visit. Perishable and non-perishable foods were observed to be properly stored. LPA observed sufficient room in the fridge for clients to store snacks and beverages. All knives and cleaning supplies were observed to be inaccessible at time of visit.

Outside area was observed free of clutter and obstruction. There was a shaded seating area with furniture appropriate for outdoor use. Parking is located in the front of the building . The vehicles used for client transportation are properly registered and current at this time. LPA did not observe any obstructions or hazards during the visit.

RECORDS: Records review began at 01:50pm, six (6) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. Five (5) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the facility appropriate training.

MEDICATIONS: Medications review began at approximately 02:45pm The medications are centrally stored in a medication cart that was observed inaccessible to clients at this time. Medications are properly documented on the centrally stored medications and destruction record.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ONEGENERATION - MARK TAPER J.O.Y. PROGRAM	FACILITY NUMBER: 191222639
	VISIT DATE: 09/05/2023

NARRATIVE

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Continued from 809-C

INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. At this time, the staff will continue to keep up signs that promotes good hand hygiene and symptoms of COVID. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate at this time.

Between 3:00pm - 3:30pm the LPA interviewed five (5) staff members. Clients were preparing to leave the facility.

Pursuant the California Code of Regulations, Title 22, Division 6, Chapter 8, the following deficiency was observed and cited during the visit (See 809-D)

Exit Interview Conducted / Appeal Rights and a copy of this report has been issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Brian Balisi
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 09/05/2023 04:18 PM - It Cannot Be Edited

Created By: Brian Balisi On 09/05/2023 at 04:04 PM

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
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ONEGENERATION - MARK TAPER J.O.Y. PROGRAM	FACILITY NUMBER: 191222639
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/05/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

82088(e)(1)

Fixtures, Furniture, Equipment, and Supplies

(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in two (2) client restrooms the water temperature measured below the required temperature at 101 and 103 degrees F, which poses a potential health and safety risk to persons in care.
	POC Due Date: 09/22/2023
	Plan of Correction
1 2 3 4	Program Director agreed to submit a work order to adjust the water temperature and provide proof of work order and scheduled date of initial visit. Then take water temperatures in client restrooms at varying times of the day for a consecutive 5-day period, record the temperatures on a log, and submit log to LPA via email by EOD on 09/22/2023.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Desaree Perera

LICENSING EVALUATOR NAME:

Brian Balisi

LICENSING EVALUATOR SIGNATURE:

DATE: 09/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

LIC809 (FAS) - (06/04)

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