197803676-5-16-2024-28-AS-NGAA-D5BUWU-20240516155720

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197803676
Report Date: 05/16/2024
Date Signed: 05/16/2024 03:57:26 PM

Document Has Been Signed on 05/16/2024 03:57 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	STRIDE		FACILITY NUMBER:	197803676
ADMINISTRATOR/ DIRECTOR:	HUNT, RENEE DENISE		FACILITY TYPE:	735
ADDRESS:	2059 RAELYN PLACE		TELEPHONE:	(626) 961-5101
CITY:	WEST COVINA	STATE: CA	ZIP CODE:	91792
CAPACITY: 4		CENSUS: 4	DATE:	05/16/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:15 PM
MET WITH:	Marina Rios, Assistant Administrator		TIME VISIT/ INSPECTION COMPLETED:	04:00 PM

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Licensing Program Analyst (LPA) Noemi Galarza made an unannounced annual inspection visit. The purpose of the visit was explained to Assistant Administrator Marina Rios. The facility is an Adult Residential Facility (ARF) that serves level 3 developmentally disabled residents ages 59 and under vendored by San Gabriel/Pomona Regional Center. The facility is a single story home located in a residential neighborhood that is licensed for four (4) ambulatory only developmentally disabled clients ages 18 - 59. The home consists of three (3) client bedrooms, one (1) staff room, 2 bathrooms, kitchen, dining room, living room, backyard patio area, and attached garage with laundry area. The following 12 (CARE) tool domains were utilized during the inspection.

Infection Control: The facility staff are using appropriate hand hygiene cleaning and disinfecting the home. An Infection Control Plan was reviewed.

Physical Plant/Environment Safety: The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Smoke and carbon monoxide detectors were tested and are operation. The facility has one (1) fully charged fire extinguisher. Hot water temperature readings measured between the required 105 - 120 degrees Fahrenheit. Storage areas for cleaning solutions/toxins, knives, and hazardous items were inaccessible to clients.

A discarded dresser was observed in the side yard area. A citation was issued.

Operational Requirements: The Program Design was reviewed. Fire clearance is approved for four (4) ambulatory only residents. Care and supervision to meet the clients needs was observed. No special equipment and supplies are used by clients. Facility manages residents P & I monies. The Surety Bond expires 6/1/2025.

Staffing: A total of three (3) staff members provide care and supervision to the clients.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: STRIDE	FACILITY NUMBER: 197803676
	VISIT DATE: 05/16/2024

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Personnel Records/Staff Training: Three (3) staff files were reviewed and contained criminal background clearance, in-service training, 1st Aid/CPR training, and health screening. Administrator certificate expires 8/6/2025.

Resident Rights/Information: Resident Personal Rights poster is posted in the common area. Internet access is available for clients. Physician's orders are on file.

Resident Records/Incident Reports: Four (4) resident files were reviewed containing admission agreements, Physician's Reports, IPPs, medical/functional assessments, Behavior Reports, TB clearance, personal rights, medical consent, medication records, and P & I trust account records.

Food Service: The kitchen was inspected and has sufficient supply of 2 day perishable & 7 day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be clean and sanitary. An freezer and extra food supply is stored in the garage.

Health Related Services: Residents are assisted with self administration of prescription and non-prescription medications. Medications records were reviewed. Centrally stored medications are kept in a safe and locked place not accessible to clients in care. Medications are given according to Physician directions. 30-Day supply of medications were observed.

Incident Medical and Dental: All residents have a Needs and Services Plan and updated medical assessments.

Disaster Preparedness, and Emergency Intervention: A current LIC 610D updated form "Emergency Disaster Plan/Disaster and Mass Casualty Plan LIC 610D was reviewed.

The last Fire/Emergency Drill was conducted on 2/28/2024.

Emergency Intervention: No manual restraints, seclusion, or de-escalation techniques are used.

Per Title 22, California Code of Regulations, a deficiency was cited.

Exit interview with Assistant Administrator was conducted. A copy of the report/appeal rights were provided.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Noemi Galarza
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/16/2024 03:57 PM - It Cannot Be Edited

Created By: Noemi Galarza On 05/16/2024 at 03:06 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: STRIDE	FACILITY NUMBER: 197803676
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/16/2024

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
1 2 3 4	Based on observation, the licensee did not comply with the section cited above because a clothing dresser was observed discarded on the side yard area, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/31/2024
	Plan of Correction
1 2 3 4	Administrator agreed to submit picture proof that the dresser has been discarded/removed.

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:

Lisa Hicks

LICENSING EVALUATOR NAME:

Noemi Galarza

LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2024

LIC809 (FAS) - (06/04)

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