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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001736
Report Date: 03/24/2023
Date Signed: 03/24/2023 12:14:28 PM

Document Has Been Signed on 03/24/2023 12:14 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
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:VOCATIONAL VISIONSFACILITY NUMBER:
306001736
ADMINISTRATOR:MERCY GORDONFACILITY TYPE:
775
ADDRESS:23612 ALAMBRETELEPHONE:
(949) 837-7280
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY: 160CENSUS: 64DATE:
03/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Laura ForsytheTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced annual required visit. LPA arrived to the facility was greeted by receptionist and granted entry. LPA met with Laura Forsythe, Administrator and explained the nature of the visit.

At 9:15am LPA accompanied by Administrator began the tour of the day program. LPA observed that the facility has designated rooms for different activities which include but are not limited to isolation room, club house, nurse’s station/health related services, activity room and kitchen used for classes. The facility has a private changing area for clients use, 2 restrooms in the first floor and 4 restrooms in the second floor. LPA tested the hot water temperature and the measurement was 118.2 Fahrenheit Degrees. During the tour LPA did not observe any items accessible to clients which would pose a risk to their health and safety. Medication is locked and stored in nurse’s station inaccessible to clients in care. The facility maintains a locked location for chemicals and toxins. LPA observed an outdoor area designated for clients use with picnic tables and swings for clients that have a wheelchair for sensory activity. Vehicle maintenance logs are maintained. Evacuation plan, client’s rights, facility license and emergency disaster plan and emergency exits are posted. LPA was provided with fire safety maintenance records dated 03/21/2023. Fire extinguishers are charged and mounted throughout the facility; last service date was 05/04/2022. Fire/disaster drills are conducted every six months. Fire drill last dated was 10/11/2022. LPA reviewed five staff records assessing for training logs, first aid/CPR, criminal record clearance, personnel record job application, health screening and TB test results, criminal record statement, and employee rights. LPA reviewed seven client records assessing for admissions agreement, medical assessment, TB test results, consent forms, need and services plans, and personal rights. No P&I money is being handled at the day program.

Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.
This report was reviewed with the Administrator and a copy of this report was provided to the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2023
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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