336409381-5-10-2023-18-AS-CNWE-CRPQHW-20230510121149

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336409381
Report Date: 05/10/2023
Date Signed: 05/10/2023 12:11:54 PM

Document Has Been Signed on 05/10/2023 12:11 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	BASIC OCCUPATIONAL TRAINING CENTER SAN JACINTO		FACILITY NUMBER:	336409381
ADMINISTRATOR:	MITZIE YODITES		FACILITY TYPE:	775
ADDRESS:	1215 BUENA VISTA, STE F,G & H		TELEPHONE:	(951) 487-2725
CITY:	SAN JACINTO	STATE: CA	ZIP CODE:	92583
CAPACITY: 75		CENSUS: 57	DATE:	05/10/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Dana Garcia, Case Manager		TIME COMPLETED:	12:15 PM

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On 5/10/2023, Licensing Program Analyst (LPA) Chinwe Nwogene arrived unannounced at the facility to conduct an annual inspection. LPA Nwogene met with Case Manager, Dana Garcia who was informed of the purpose of visit. LPA toured the facility inside and out with Dana Garcia.

Tour included:

Kitchen; LPA toured the kitchen and observed kitchen to be clean. LPA observed emergency food and water. There were sufficient utensils and dishware for the approved capacity. The refrigerator and stove are in working order. Sharps are stored in a locked pantry, available only to authorized individuals. Trash cans has tight-fitting lids. All need appliances were present and shown to be in working condition and clean. The fridge was measured at 40 degrees Fahrenheit and Freezer was measures at 0 degrees Fahrenheit.

Lunch Room; LPA toured the lunch room and observed area to be clean and furnitures in good condition. Temperature was 70 degrees Fahrenheit.

Hallway; LPA toured the hallway and observed hallway to be clean with no pathway obstruction. LPA inspected the fire extinguisher and found it to be in compliance and record to be up to date. Carbon monoxide & smoke detector are functioning properly.

Bathroom; LPA toured all facility bathrooms and observed bathrooms to be clean and equipped. There is also a good number of personal toiletries available for the clients in care. The hot water measured at 107 degrees Fahrenheit

Continue on LIC809-C

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BASIC OCCUPATIONAL TRAINING CENTER SAN JACINTO	FACILITY NUMBER: 336409381
	VISIT DATE: 05/10/2023

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Continued from LIC809.

Offices and Classrooms; LPA toured Offices and Classrooms and observed rooms to be clean and well furnished with tables, chairs and cabinets.

Laundry; LPA toured the laundry room and observed room to be clean. Washing machine and dryer are all in good repair and sufficient for approved census. Cleaning supplies are stored away in the laundry room, inaccessible to clients.

Records: All staff present have a criminal record clearance in file and are confirmed as being associated with the facility. Three #3 staff and #3 clients’ records were reviewed. All required postings, including COVID’s postings, were posted near the entryway and throughout the facility. The administrator certificate expired on 4/21/2023. Dana stated the administrator renewal packet has been sent to the department.

Interview; LPA interviewed three #3 staff and #3 clients present.

No deficiencies noted at the time of visit. An exit interview was conducted, and a copy of this report was reviewed with and provided to Dana Garcia.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Chinwe Nwogene
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC809 (FAS) - (06/04)

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