336406642-4-29-2024-18-AS-YDEO-D4SS2R-20240429132957

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336406642
Report Date: 04/29/2024
Date Signed: 04/29/2024 01:32:06 PM

Document Has Been Signed on 04/29/2024 01:32 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	VALLEY RESOURCE CENTER		FACILITY NUMBER:	336406642
ADMINISTRATOR/ DIRECTOR:	ANDREA WELLS		FACILITY TYPE:	775
ADDRESS:	1285 N. SANTA FE, SUITE B		TELEPHONE:	(951) 766-8659
CITY:	HEMET	STATE: CA	ZIP CODE:	92543
CAPACITY: 35		CENSUS: 31	DATE:	04/29/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:35 AM
MET WITH:	Pedro Zambrano, Director		TIME VISIT/ INSPECTION COMPLETED:	01:35 PM

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Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an Annual Inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction and visit purpose. Upon arrival LPA learned that thirty-one (31) clients are enrolled at this facility and there are currently eight (8) staff. The facility has an Infection Control Plan on file.

LPA Delgado interviewed of five (5) client interviews and five (5) staff interviews.

Client Records/Incident Reports/Personal Rights/Information- LPA began review of client records. Five (5) records were reviewed. LPA reviewed for admission agreement, needs and services plan, IPP, medical assessment and TB test results, identification and emergency information, client rights notification and register of clients.

Personnel Records/Training/and Staffing- LPA began review of employee records. Five (5) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance, exemptions, transfer of a criminal record clearance, health screening and TB test results, (8) hours training verification, Administrator continuing education (30) hours every 24 months.

Food Service- Food prep areas are clean and organized. Snacks food items are stored in the kitchen. Emergency food is not sufficient and water supply is present. There is a locked location for chemicals. Sharps locked inside a cabinet with a Ajax observed in the kitchen and sharps for office use are locked in offices.

(Continued on Page 2)

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024

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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: VALLEY RESOURCE CENTER	FACILITY NUMBER: 336406642
	VISIT DATE: 04/29/2024

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(Continued from Page 1)

Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility is maintained at a comfortable temperature for the participants. Lighting is sufficient for safety and comfort. Water temperature measured 115 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals. All outdoor and indoor passageways are free of obstruction. There is a shaded rest area provided for clients. There is a telephone working at this location. The LIC 610, emergency disaster plan is maintained. There are no firearms at this facility.

No medications are centrally stored.

LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. LPA requested the fire sprinkler system to be tested and Director contacted the Exceed CEO Lee Trisler and ADT Commercial, Director stated that the CEO stated we can not test at this time. Director showed LPA the ADT 5 year sprinkler inspection that was done on 02/24/2024. Carbon monoxide detector were tested and found to be operational. Fire extinguishers was recharged as of 04/8/2024 . The facility is conducting emergency disaster/fire drills monthly; last done on 03/29/2024.

Based on the information received during this visit today in the areas reviewed, there are three (3) deficiencies are being cited per Title 22, Division 6 of The California Code of Regulations.

This LIC 809 and 809-C, 809-D and Appeal Rights reports was reviewed with and a copy provided to the facility representative.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024

LIC809 (FAS) - (06/04)

Page: 2 of 4

Document Has Been Signed on 04/29/2024 01:32 PM - It Cannot Be Edited

Created By: Yolanda Delgado On 04/29/2024 at 01:13 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: VALLEY RESOURCE CENTER	FACILITY NUMBER: 336406642
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

82066(a)(10)

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator, and each employee. Each personnel record shall contain the following information: (10) A health screening, as specified in Section 82065(g). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on Delgado's observation, interview and record review, the licensee did not comply with the section cited above in one of six staff files reviewed and S1 did not have a health screening documented which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/20/2024
	Plan of Correction
1 2 3 4	Licensee will obtain health screening for staff and email copy to LPA by POC due date.

Type B

Section Cited

CCR

82068.2(f)(1)(B)

Needs and Services Plan

(f) The completed Needs and Services Plan shall include: (1) The client's desires and background and formal supports, obtained from the client's family or his/her authorized representative, if any, regarding the following: (B) A written medical assessment including primary physician, health problems and medical history, prescribed medications and their strength, quantity, frequency required and purpose as specified in Section 82069(b)(3). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on Delgado observation, interview and record review, the licensee did not comply with the section cited above in one of six client records reviewed and R1 did not have a current written medical assessment which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/20/2024
	Plan of Correction
1 2 3 4	Licensee will obtain a current medical assessment and email copy to LPA by POC due date.

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:

Jazmond D Harris

LICENSING EVALUATOR NAME:

Yolanda Delgado

LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 04/29/2024 01:32 PM - It Cannot Be Edited

Created By: Yolanda Delgado On 04/29/2024 at 01:13 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: VALLEY RESOURCE CENTER	FACILITY NUMBER: 336406642
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

82076(a)(14)

Food Service

(a) In day programs providing meals to clients, the following shall apply: (14) Pesticides and other similar toxic substances shall not be stored in food storerooms, kitchen areas, food preparation areas, or areas where kitchen equipment or utensils are stored. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on LPA Delgado's observation and interview, the licensee did not comply with the section cited above in which Ajax cleaning solution was locked with sharps for kitchen use next to each other which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/20/2024
	Plan of Correction
1 2 3 4	Licensee will removed toxic substances from area and conduct in-service training with staff and submit by email to LPA by POC due date

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Jazmond D Harris

LICENSING EVALUATOR NAME:

Yolanda Delgado

LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024

LIC809 (FAS) - (06/04)

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