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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336413140
Report Date: 07/22/2022
Date Signed: 07/22/2022 03:43:24 PM

Document Has Been Signed on 07/22/2022 03:43 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:SUPPORTING UNLIMITED POSSIBILITIES CATLIN HOUSEFACILITY NUMBER:
336413140
ADMINISTRATOR:DEBORAH STANGELFACILITY TYPE:
735
ADDRESS:33708 CATLIN AVETELEPHONE:
(951) 325-8140
CITY:HEMETSTATE: CAZIP CODE:
92545
CAPACITY: 4CENSUS: 3DATE:
07/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Frank DeAguilar - Facility ManagerTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of completing the facility's Annual Inspection. LPA Colvin met with Staff Joseph Garrett and advised of the purpose of the visit, and that the Annual Inspection will be limited to Infection Control only. Facility Manager Frank DeAguilar arrived prior to the conclusion of the inspection and provided additional assistance and information. Below is a summary of what was observed:

Infection Control: LPA Colvin went over COVID-19 best practices for infection control and prevention with staff Joseph Garrett, who LPA Colvin found to be successfully incorporating the several aspects of the facility's Mitigation Plan. Residents have hand sanitizer available to them, and the bathrooms were stocked with hand soap and paper towels. While touring the facility, LPA Colvin observed postings throughout the facility for cough etiquette, social distancing, and infection control. LPA Colvin requested to view the facility's PPE supplies (gloves, masks, and sanitizer, and isolation gowns) which LPA Colvin observed to be sufficient for a 30-day supply and is accessible to staff. LPA Colvin went over 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 Colvin inquired as to if staff have been fit tested for N95 masks, and staff Joseph Garrett confirmed that they have conducted fit testing for all staff. LPA Colvin informed Facility Manager Frank DeAguilar that fit testing is to be annually, so staff will need to be fit tested again. LPA Colvin also inquired about if the facility is still screening their residents daily for COVID-19 symptoms, which includes checking their temperature. Staff Joseph Garrett confirmed that staff are continuing to monitor residents’ symptoms, and that both staff and visitors are screened for COVID-19 symptoms prior to entering the facility. LPA Colvin confirmed this as LPA Colvin's temperature was taken upon entry to the facility, and LPA Colvin signed in on the visitor log, where their temperature is recorded.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2022
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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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: SUPPORTING UNLIMITED POSSIBILITIES CATLIN HOUSE
FACILITY NUMBER: 336413140
VISIT DATE: 07/22/2022
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Additionally, LPA Colvin observed several present to not be wearing any type of face covering when LPA Colvin initially entered the facility. At this time, face coverings are still required in all residential facilities. LPA Colvin will be issuing a TA Advisory Note staff not wearing a face covering. Staff did all doff a face mask after LPA Colvin entered the facility and announced the purpose of the inspection. LPA Colvin inquired about if the facility is screening their residents daily for COVID-19 symptoms, which includes checking their temperature. Facility Manager Frank DeAguilar confirmed that residents are being screened daily. LPA Colvin observed a sign-in sheet at the front door of the facility, and confirmed that visitors and staff are being screened for symptoms prior to entering the facility.

An exit interview was conducted with Facility Manager Frank DeAguilar and a copy of this report and LIC9102-TA Advisory Note was provided.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2022
LIC809 (FAS) - (06/04)
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