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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881049
Report Date: 05/22/2023
Date Signed: 05/22/2023 02:26:39 PM

Document Has Been Signed on 05/22/2023 02:26 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:RIGHT AT HOMEFACILITY NUMBER:
331881049
ADMINISTRATOR:RUSH, LENAFACILITY TYPE:
735
ADDRESS:861 W. CRESTVIEW ST.TELEPHONE:
(562) 900-3109
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY: 4CENSUS: 4DATE:
05/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Manager- Sheena HumphreyTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Victoria Chitgian made an unannounced visit for a required annual inspection. Facility is an Adult Residential Facility licensed for four (4) ambulatory clients. LPA was greeted and granted entry by the Facility Manager Sheena Humphrey.

LPA toured the facility inside and out. Outdoor and indoor passageways were kept free of obstruction. The facility has charged fire extinguishers, operating fire alarm systems, and carbon monoxide detectors. LPA toured the kitchen. Food was stored in a safe and healthful manner. The facility had a two (2) day supply of perishable food items and seven (7) day supply of nonperishable food items. LPA toured the client bedrooms. The client bedrooms had the required furniture and functional lighting. The facility had a supply of additional linen and extra hygiene items for the clients. The facility had a complete first aid kit available and the last disaster drill was conducted on 4/28/2023. Cleaning supplies, medications, and sharps were kept locked and inaccessible to the clients. LPA toured the client bathrooms. The hot water temperature measured above the required limits at 138 degrees Fahrenheit. Deficiency was issued. House Manager called the licensee Mr. Rush to adjust the water heater. The outside of the facility had a shaded area with seating for client comfort. The facility does not have bodies of water.

LPA reviewed staff and client files. Staff files had the required documentation including a health screening report and first aid/CPR certification. LPA discovered the Administrators HIV/TB training was taken over 2 years ago, and is no longer valid. Technical violation issued. Client files had the required documentation including an admission's agreement, updated physician's reports, and appraisal/needs & services plans. LPA observed one clients’(C1) placement agreement was missing 80068(a)(1) objection of admission. LPA issued a technical violation. LPA reviewed medications. Medications were dispensed appropriately according to the physician's orders. Licensee has secured each consumer’s personal property and cash resources. Sufficient staff are employed and present in the facility to meet the needs of the consumers in care.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Victoria Chitgian
LICENSING EVALUATOR SIGNATURE: DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/22/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: RIGHT AT HOME
FACILITY NUMBER: 331881049
VISIT DATE: 05/22/2023
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 One(1) deficiency and two (2) technical violations issued. An exit interview was conducted where this report, LIC 809, LIC-809-D, LIC 9102, and appeal rights was discussed and provided to the Facility Manager Sheena Humphrey, at the end of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Victoria Chitgian
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/22/2023 02:26 PM - It Cannot Be Edited


Created By: Victoria Chitgian On 05/22/2023 at 02:03 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
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: RIGHT AT HOME
FACILITY NUMBER: 331881049

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80088(e)(2)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (2) Taps delivering water at 125 degrees F (51.6 degrees C) or above shall be prominently identified by warning signs.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited aboveas the hot water in the bathroom measured at 138 degrees F, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/26/2023
Plan of Correction
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Licensee will repair and/or adjust the water heater to deliver water between 105-120 degrees F, and submit photograph proof to CCLD via email by POC due date above. If water does not reduce in temperature within required limits, Licensee will put a sign "Caution, Hot Water" and submit proof to LPA by POC due date 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:Efren Malagon
LICENSING EVALUATOR NAME:Victoria Chitgian
LICENSING EVALUATOR SIGNATURE:
DATE: 05/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/22/2023


LIC809 (FAS) - (06/04)
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