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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005561
Report Date: 06/22/2022
Date Signed: 06/22/2022 12:23:14 PM

Document Has Been Signed on 06/22/2022 12:23 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:RYAN'S REACH R&R IIFACILITY NUMBER:
306005561
ADMINISTRATOR:MICHAELIS, CHARLES WFACILITY TYPE:
735
ADDRESS:2009 CATALINA AVETELEPHONE:
(714) 396-7678
CITY:SANTA ANASTATE: CAZIP CODE:
92705
CAPACITY: 6CENSUS: 3DATE:
06/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Elaine SanchezTIME COMPLETED:
12:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one year infection control annual visit. LPA was greeted, granted entry by staff and explained the reason for the visit. Staff called Administrator (AD) Elaine Sanchez who arrived and was present for the visit. AD Sanchez has a current administrators certificate that expires on 07/23/2023. LPA observed a screening log book, and temperature thermometer for screening clients and visitors. At 10:30pm LPA toured the facility with AD Sanchez. There were three clients present at the facility. Client rooms have the necessary requirements, night stand, chair, lamp and storage space. Bathrooms were clean and organized. Water temperature was measured at 120 degrees Fahrenheit in bathroom #1, 118.2 degrees Fahrenheit in bathroom #2, and 130 degrees Fahrenheit in bathroom #3. There was a first aid kit with all the required elements in the locked medication cabinet. In the garage LPA Haley observed an adequate PPE supply of gloves, surgical mask, and hand sanitizers. Further, LPA observed an emergency food and water supply stored in the garage. LPA toured the backyard and observed a side exit gate that was self closing and self latching. The backyard was clean and free of clutter. In the backyard, LPA Haley observed a shaded area equipped with tables and chairs. The facility had a two day supply of perishable food items and seven days supply of nonperishable food items. The stove was clean and all burners were operational. All knives and sharp objects were locked in the medication cabinet. All hazardous chemical are locked below the sink. There were no bodies of water observed. All smoke detectors were tested and are operational. Deficiencies are being cited under California Code of Regulations, Title 22, Division 6, Chapter 1. An exit interview conducted and a copy of the report and appeal rights were provided to the Administrator Elaine Sanchez.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jerome Haley
LICENSING EVALUATOR SIGNATURE: DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/22/2022
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 06/22/2022 12:23 PM - It Cannot Be Edited


Created By: Jerome Haley On 06/22/2022 at 12:15 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
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: RYAN'S REACH R&R II
FACILITY NUMBER: 306005561

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/22/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80088
(e)(1) Hot water temperature controls shall be maintatined 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 (48.8 degrees C)


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, of water temperture in bathroom three at 130 degrees F, the licensee did not comply with the section cited above which poses an immediate health, and safety risk to clients in care.
POC Due Date: 06/23/2022
Plan of Correction
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Licensee will adjust water temperature to meet the requirements cited above.
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:Luz Adams
LICENSING EVALUATOR NAME:Jerome Haley
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2022


LIC809 (FAS) - (06/04)
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