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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880539
Report Date: 05/16/2022
Date Signed: 05/16/2022 09:58:35 AM

Document Has Been Signed on 05/16/2022 09:58 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:ROBINSON RANCH ADULT HOME IIFACILITY NUMBER:
331880539
ADMINISTRATOR:ROBINSON, OLGAFACILITY TYPE:
735
ADDRESS:1260 PASEO GRANDE RDTELEPHONE:
(951) 340-3127
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY: 6CENSUS: 4DATE:
05/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:House Manager, Blanca NinoTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Jennifer Semin arrived at the facility unannounced after completing a COVID-19 Risk Assessment Screening for the facility. LPA met with House Manager, Blanca Nino. LPA spoke with Licensee/Administrator Olga Robinson via telephone and advised her of the purpose of the visit, and that the Annual Inspection will be limited to Infection Control only, however, she was unable to attend.
Infection Control: LPA went over COVID-19 best practices for infection control and prevention with Ms. Robinson and Ms. Nino who are successfully incorporating the facility's approved Mitigation Plan. Clients have hand sanitizer available to them and the bathrooms were stocked with hand soap and paper towels. LPA observed the facility to have multiple postings throughout the facility for cough etiquette, proper hand washing procedure, social distancing, and emergency contact information for local fire department and client's physicians. LPA requested to inspect the facility's Personal Protective Equipment (PPE) supply, which was conveniently located in the kitchen cabinet. LPA observed a box of PPE ready that would be dedicated for isolation room, along with a trash cans to put inside and outside of an isolation room. In addition to the supplies for the isolation room, LPA observed a shed dedicated to storing all PPE items such as gloves, face shields, gowns, surgical masks, N95 masks, disinfectant and hand sanitizer. LPA confirmed that the facility has plenty of PPE readily available for use. LPA confirmed with Ms. Robinson and Ms, Nino that the facility has a plan for isolating client(s) should they test positive for COVID-19. Two clients share a bedroom, and the other two have private rooms. Should the client in the private room test positive, they will isolate in their own room. However, should only one of the two clients that share a room test positive, the non-positive client will move with the client in the private room (temporarily) for the purpose of isolating.
LPA and Ms. Robinson discussed the various recommended training for facility staff in relation to COVID-19 and confirmed that staff have been trained on various aspects of infection control, recognition of symptoms of COVID-19, and donning/doffing PPE. LPA inquired as to if staff have been fit tested for N95 masks, and Ms. Robinson informed LPA that staff have been fit tested.
An exit interview was conducted where this report was discussed and provided to Ms. Nino.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Jennifer Semin
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2022
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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