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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197802315
Report Date: 08/26/2024
Date Signed: 08/26/2024 09:01:48 PM

Document Has Been Signed on 08/26/2024 09:01 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:VRAM ADULT FAMILY HOMEFACILITY NUMBER:
197802315
ADMINISTRATOR/
DIRECTOR:		LAURETTA, AURAFACILITY TYPE:
735
ADDRESS:2327 HILLVIEW AVE.TELEPHONE:
(323) 721-9618
CITY:MONTEREY PARKSTATE: CAZIP CODE:
91754
CAPACITY: 4CENSUS: 4DATE:
08/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:13 AM
MET WITH:Vincent R Lauretta, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:44 PM
NARRATIVE
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Licensing Program Analyst (LPA) Alberto Lopez conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA met with Vincent Lauretta, administrator and explained the reason of the visit. The facility is approved for serve Developmentally Disabled Adults, four (4) ambulatory clients. The facility is licensed as a level 2 home vendored by East Los Angeles Regional Center.

The following twelve (12) tool domains were observed and reviewed: Infection Control, Physical Plant/Environmental Safety, Operational Requirements, Staffing, Personal Records-Training, Client Rights/Information, Client Records/Incident Reports, Food Service, Health Related Services, Incidental Medical Services, Disaster Preparedness and Emergency Intervention.

1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility still encourages hand washing, still checking client temperature twice a day and staff disinfected the facility every shift. The facility has an Infection Control Plan and COVID-19 mitigation plan in place.

2. Physical Environmental and Safety: The facility is a single story house and located on residential neighborhood area. The facility includes living room #1, kitchen, dining area, den/staff office/client's activity room, two client shared bedrooms and 1 client bathrooms, laundry room and a detached garage. required furniture and bedding and sufficient lighting and closet space. The client bathroom is clean, sanitary and in a good working condition. The hot water was tested between 100.0 – 136.7 degrees F which are not within the Title 22 regulation. The appliances in the living room and kitchen are working well. The knives and sharp utensils are stored and locked in the cabinet behind the washer and dryer.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 9
Document Has Been Signed on 08/26/2024 09:01 PM - It Cannot Be Edited


Created By: Alberto Lopez On 08/26/2024 at 03:26 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
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: VRAM ADULT FAMILY HOME
FACILITY NUMBER: 197802315

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients 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
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Based on observation, the licensee did not comply with the section cited above. Water measured 100 to 136.7 degrees F which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/27/2024
Plan of Correction
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Administrator will adjust water and keep a log for 7 days and send it to LPA as proof of correction.
Type A
Section Cited
CCR
80066(a)(12)(B)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (12) For employees that are required to be fingerprinted pursuant to Section 80019: (B) Documentation of either a criminal record clearance or exemption as required by Section 80019(e).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, record review, the licensee did not comply with the section cited above in 2 of 4 counts, two staff are not associated with facility which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/27/2024
Plan of Correction
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Administrator will associated 2 staff to faciltiy and send proof to LPA.
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:Lisa Hicks
LICENSING EVALUATOR NAME:Alberto Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2024


LIC809 (FAS) - (06/04)
Page: 2 of 9
Document Has Been Signed on 08/26/2024 09:01 PM - It Cannot Be Edited


Created By: Alberto Lopez On 08/26/2024 at 03:26 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
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: VRAM ADULT FAMILY HOME
FACILITY NUMBER: 197802315

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. The home roof is in need of repair or replacement which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/30/2024
Plan of Correction
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Licencee will repair or replace the roof and send proof to LPA by POC date.
Type B
Section Cited
CCR
80088(b)
Fixtures, Furniture, Equipment, and Supplies
(b) All window screens shall be in good repair and be free of insects, dirt and other debris.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [observation, the licensee did not comply with the section cited above. There are 3 screens that need repair or replacement due to tears which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/06/2024
Plan of Correction
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Licencee will repair or replace screens and send proof to LPA by POC date.
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:Lisa Hicks
LICENSING EVALUATOR NAME:Alberto Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2024


LIC809 (FAS) - (06/04)
Page: 3 of 9
Document Has Been Signed on 08/26/2024 09:01 PM - It Cannot Be Edited


Created By: Alberto Lopez On 08/26/2024 at 03:26 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
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: VRAM ADULT FAMILY HOME
FACILITY NUMBER: 197802315

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80077.3(a)(3)(C)
Care for Clients who Lack Hazard Awareness or Impluse Control
(C) Following the disaster and mass casualty plan specified in Section 80023, fire and earthquake drills shall be conducted at least once every three months on each shift and shall include, at a minimum, all facility staff who provide or supervise client care and supervision.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. Which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/26/2024
Plan of Correction
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Facility provided proof of correction during visit. *****NO FURTHER ACTION REQUIRED****
Type B
Section Cited
CCR
80066(e)
Personnel Records
(e) All personnel records shall be maintained at the facility site.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, record review and observation, the licensee did not comply with the section cited above administrator file was not at facility for inspection which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/30/2024
Plan of Correction
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Administrator will keep all personnel files including Administrator's file at facility and send proof to LPA by POC date.
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:Lisa Hicks
LICENSING EVALUATOR NAME:Alberto Lopez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2024


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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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: VRAM ADULT FAMILY HOME
FACILITY NUMBER: 197802315
VISIT DATE: 08/26/2024
NARRATIVE
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All the chemicals and cleaning supplies are stored and were not locked in the kitchen and not accessible to client. The extra linen and personal hygiene products are stored in the hallway cabinet/closet. The facility does not have a working landline telephone system for client to use. The hallway light is always on during night timed for client to access the non-private bathrooms. LPA inspected the carbon monoxide detectors and smoke detectors, and they are all working well. The passageway, walkway and patio are free of obstruction.

3. Operational Requirement: The facility is licensed for four (4) ambulatory clients and currently all four (4) clients are ambulatory. The last fire/earthquake drill was conducted on 08/01/2024 . Clients can attend the community events/activities if there's an opportunity and chance. The facility has a shaded area with table and chairs for client to utilize the outdoor activity.

4.Staffing: The facility has sufficient staffing in place. LPA reviewed the NOC shift staff files, and staff have current CPR certificates on file.

5. Personnel Records-Training. The facility staff files are store in facility but one file was missing. All the staff are over 18 years old and older, fingerprint cleared but 2 staff are not associated with the facility. The administrator is Vincent Lauretta and his administrator certificate expiration date is 08/23/24 and he has her proof that he has applied for renewal. LPA reviewed three (3) staff files and they all are missing health screening, and required training hours.

6. Client right-Information: Currently there's no client required postural support. The facility also served client that has internet service and provide at least one internet access device in the facility.

7. Client Records- Incident Reports: The client files are stored in the staff office in the file cabinet. All client files have the required documents include face sheet, admission agreement, functional capability assessment, health screening and TB Test, Individual Program Plan (IPP), ambulatory status and medication list.
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC809 (FAS) - (06/04)
Page: 8 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: VRAM ADULT FAMILY HOME
FACILITY NUMBER: 197802315
VISIT DATE: 08/26/2024
NARRATIVE
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8. Food Service: Currently no client is on modified diet. The facility has two days perishable and seven days non-perishable food supply. The food is stored probably. The facility refrigerator is maintained within the required temperature.

9. Health Related Services: The medication is centrally stored and locked in safe in a locked closet. LPA inspected all three (3) clients medication, and they were all updated and accurate at the time of visit. They all have 30 days’ supply of medication.



10.Incidental Medical Services: Currently there's no client has any restricted health condition or prohibited health condition in the facility.

11. Disaster Preparedness: The facility has an emergency disaster plan dated on 08/09/2024 and the last fire/emergency drill was conducted on 08/01/2024 and the facility has two alternative temporary shelter location. LIC610 needs updating.

12. Emergency Intervention: The facility does not use any restraint on clients, but all staff have an updated CPI training.


deficiencies were observed during the visit. technical advisories were provided.

Exit Interview conducted and a copy of the report and appeal rights was provided to Vincent Laureta
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024
LIC809 (FAS) - (06/04)
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