198603563-7-30-2024-28-AS-TRES-D7P2LP-20240730172954

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603563
Report Date: 07/30/2024
Date Signed: 07/30/2024 05:30:11 PM

Document Has Been Signed on 07/30/2024 05:30 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME:	TELECARE CITRUS HOUSE		FACILITY NUMBER:	198603563
ADMINISTRATOR/ DIRECTOR:	SAWLSVILLE, BRIAN		FACILITY TYPE:	772
ADDRESS:	7725 LEEDS STREET		TELEPHONE:	(562) 445-3001
CITY:	DOWNEY	STATE: CA	ZIP CODE:	90242
CAPACITY: 16		CENSUS: 13	DATE:	07/30/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:55 PM
MET WITH:	Pedro Burgos; Administrator		TIME VISIT/ INSPECTION COMPLETED:	05:30 PM

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Licensing Program Analyst (LPA) Tyler Reyes conducted the required annual inspection. LPA arrived unannounced and met with Pedro Burgos (Administrator) and explained the purpose of today’s visit. The facility is licensed to serve 16 Ambulatory clients. Note: this is a short-term crisis residential program.

This is a 2-story facility located in an industrial area in Downey, Ca. A tour of the facility includes: First Floor: 2 client bedrooms, 2 restrooms, 1 shower room, 1 staff restroom, kitchen, patio, dining room, group activity room, clinician station, nurse station/medication room, group room (intake room), janitor closet (cleaning supplies), storage room (with hygiene products), laundry room, hygiene intake room with restroom, administrators office, elevator maintenance room, and electrical room. Second floor: 6 client bedrooms, 3 shower rooms, 3 restrooms, janitor room, laundry room, linen storage room, family/group room, medical record room, staff break room, and staff restroom.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:

Infection Control: The facility staff are using appropriate hand hygiene and gloves while assisting clients’ medications. Staff are cleaning and disinfecting throughout the day. Facility has sufficient PPE supplies and has an Infection Control Plan.
Physical Plant & Environment Safety: LPA toured facility and observed 6 clients’ bedrooms, each room had the required furniture for comfort and safety and had sufficient lighting. No bodies of water were observed at the facility. There are no security bars or weapons on the premises. Hygiene products are readily available and stored in a storage room. All storage areas for cleaning solutions, toxins, knives, and hazardous items are stored in a secured/locked area and inaccessible to clients. The last Fire/Emergency Drill was conducted on 5/8/24. Smoke detectors and carbon monoxide detectors are operable and in compliance, there is an emergency sprinkler system throughout the facility. The fire extinguishers were observed and are fully charged.
(Continued on 809-C)

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Tyler Reyes
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

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

FACILITY NAME: TELECARE CITRUS HOUSE	FACILITY NUMBER: 198603563
	VISIT DATE: 07/30/2024

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Operational Requirements: The facility maintains accurate records of accounts, personal property and/or valuables. The facility provides care and supervision as necessary to meet the client’s needs.
Staffing: There facility appears to have six direct care staff on duty, on the premises any time the clients are in the facility and seem to have sufficient staffing at all times.
Personnel Records-Training: Staff has criminal record clearance, current first aid and CPR, and ongoing training. Staff files are maintained at the facility and kept in the 2^nd floor staff office.
Client Rights-Information: Clients are provided with telephone and internet at the facility.
Client Records-Incident Reports: Client files are maintained electronically and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Needs & Services Plan.
Food Service: The kitchen was observed for the ability to prepare and serve food. Facility has a food waiver on file where facility receives three daily deliveries. Facility has sufficient supply for snacks.
Health Related Service: Staff designated to administer medication has the proper training on file. Medication is properly labeled and are centrally stored within the Medication Room and are in their original containers. During the visit today, LPA reviewed 7 clients’ medication no issues were observed.
Incidental Medical & Dental: All medications for clients are kept locked and inaccessible to other clients.
Disaster Preparedness: The facility has an Emergency Disaster Plan with contact numbers and at least 2 relocation sites.
Emergency Intervention: Clients at this facility do not have restraints.

During today’s visit LPA conducted 3 staff interviews and 2 client interviews.

Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit.

Exit interview held and a copy of the report was provided to the Administrator Pedro Burgos.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Tyler Reyes
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024

LIC809 (FAS) - (06/04)

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