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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602971
Report Date: 07/19/2022
Date Signed: 07/19/2022 09:43:56 AM

Document Has Been Signed on 07/19/2022 09:43 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:YEARLING ARF INCORPORATEDFACILITY NUMBER:
198602971
ADMINISTRATOR:MACHADO, MARYFACILITY TYPE:
735
ADDRESS:11309 YEARLING STTELEPHONE:
(714) 875-8388
CITY:CERRITOSSTATE: CAZIP CODE:
90703
CAPACITY: 4CENSUS: 4DATE:
07/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Norlan Machado; Program ManagerTIME COMPLETED:
10:00 AM
NARRATIVE
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Licensing Program Analyst (LPA) David Sicairos conducted an unannounced annual visit using the Infection Control Evaluation Tool. LPA met with Noelia Vidales and explained the reason for the visit. Program Manager Norman Machado arrived shortly thereafter. Physical Plant was toured, medications were reviewed, and food supply was inspected.

The following was observed/inspected:
  • LPA and toured the home and inspected (5) bedrooms, (2) bathrooms, living room, family room, kitchen, dining room, office area, and attached garage. The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area for the residents located in the backyard. Passageways and exits are free of obstruction. The water temperature was tested in bathroom #1 in the hallway and measured at 143.4F which is outside the required 105F - 120F degrees. Mr. Machado adjusted the water temperature during the visit. Client bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have sufficient closet space. Client beds have the required linen and the linen is in good condition. Sufficient hygiene supplies were observed for the clients in care. Smoke detectors and carbon monoxide detectors were observed throughout the facility and were tested and operable during the visit. There are multiple fire extinguishers located throughout the home which are fully charged. Kitchen appliances are clean and were operating at the time of the visit. There is a working phone on the premises. Sharps are locked in a kitchen drawer and are inaccessible to clients. Cleaning supplies and disinfectants are locked in the garage and are inaccessible to the clients. First Aid kit was fully stocked with current manual.
  • Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing.
  • Staff were observed wearing masks and screening visitors at entry.
  • Sufficient supply of 2 days perishable & 7 days non-perishable foods were observed.
  • (3) out of the (4) client medications were reviewed. Medications are centrally stored in a locked cabinet in the kitchen. Medications are documented properly and given as prescribed.
  • Staff and Client files were not reviewed during today's visit.

Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiency observed during the visit is documented on 809D. Exit interview held and a copy of the report along with appeal rights were provided.
SUPERVISORS NAME: Stefanie Coronel
LICENSING EVALUATOR NAME: David Sicairos
LICENSING EVALUATOR SIGNATURE: DATE: 07/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/19/2022
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 07/19/2022 09:43 AM - It Cannot Be Edited


Created By: David Sicairos On 07/19/2022 at 09:27 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
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: YEARLING ARF INCORPORATED

FACILITY NUMBER: 198602971

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 07/19/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80088(e)(1)
(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 physical plant tour, LPA measured water temperature in bathroom #1 and measured at 143.4F. This poses and immediate Health,Safety, and/or Personal Rights risk to the clients in care.
POC Due Date: 07/20/2022
Plan of Correction
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Program Manager adjusted water temperature during visit. Water temperature measured again during visit and measured at 118F. *CITATION CLEARED*
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Stefanie Coronel
LICENSING EVALUATOR NAME:David Sicairos
LICENSING EVALUATOR SIGNATURE:
DATE: 07/19/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/19/2022


LIC809 (FAS) - (06/04)
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