336425825-4-25-2023-18-AS-JGEE-CR8VYR-20230425165135

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336425825
Report Date: 04/25/2023
Date Signed: 04/25/2023 04:51:46 PM

Document Has Been Signed on 04/25/2023 04:51 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:	ALPHA CHRISTIAN HOMES AT REISLING		FACILITY NUMBER:	336425825
ADMINISTRATOR:	JANE ANDREA NAVARO		FACILITY TYPE:	735
ADDRESS:	857 REISLING ST.		TELEPHONE:	(951) 282-2938
CITY:	HEMET	STATE: CA	ZIP CODE:	92545
CAPACITY: 3		CENSUS: 3	DATE:	04/25/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Lourdes Pagulayan, House Manager		TIME COMPLETED:	05:05 PM

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Licensing Program Analyst (LPA) Javina George conducted an unannounced annual/1 year required visit on 04/25/23 at 1:45pm. LPA was granted entry by House Manager Lourdes Pagulayan, who was informed of the purpose of the visit. The Administrator was not available at the time of LPAs visit.

LPA conducted a tour of the interior and exterior of the facility and observed the following: the home has two stories consisting of (4) bedrooms, (3) bathrooms, office, formal dining room, den, backyard and 2 car garage.

Infection Control: the facility has an approved mitigation plan on file that was approved on 3/16/2021. LPA observed the facility to still follow their mitigation plan and conducting covid protocol such as temperature checks, sanitizing upon entry. LPA did explain that it is no longer required, however it is up to the facility and their comfort level.

Physical Plant: LPA observed the clients bedrooms which contained the required furniture. The interior and the exterior, including the floor, doors and windows were observed to be clean, clutter as well as odor free. The Fixtures and furniture were observed to be in good repair. The facility does not have a pool, or any other bodies of water on the premises. The water temperature was tested and was found to be within regulatory limits 106.5-108.2 degrees Fahrenheit.

Food Service: LPA observed the kitchen to be clean and possess equipment in good working condition. LPA observed the facility had the required 2-day perishable and 7-day non-perishable food supplies. The facility reports conduct their shopping every other week. The facility is due to go shopping this Friday 4/28/23. The sharp and dangerous objects are kept locked in the kitchen in the second drawer next to the stove.

Care & Supervision/Administration: Emergency exiting plans, emergency telephone numbers and personal rights were found posted in the facility on the wall inside of the kitchen/dining area.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

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

FACILITY NAME: ALPHA CHRISTIAN HOMES AT REISLING	FACILITY NUMBER: 336425825
	VISIT DATE: 04/25/2023

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Record Review and Resident/Staff Files: LPA observed staff #1 and staff # 3 to have expired CPR/First Aid Certification. Deficiency will be cited. The (2) two client files were found to be complete with the required documentation; appraisals and medical assessments. Additionally, LPA conducted (1) staff and (2) client interviews. The staff answered the questions with ease and confidence, as well accurately.

Incidental Medical: LPA reviewed the medications for (2) clients and found that all resident medications were accounted for, with proper labeling, and medication administration log was found to be accurate and up to date.

Disaster Preparedness: The facility has record of conducted emergency drills (earthquake, fire). The drills were observed to be conducted on a quarterly basis and the last drill was on 4/1/23, and it was for both a fire and earthquake drill. The facility's smoke and carbon monoxide combined detectors were tested and are operable. LPA observed there to be two fire extinguishers located on the premises located upstairs in the hallway and master bedroom. The facility's emergency disaster plan ( LIC 610D) was observed to not have been reviewed or updated since 4/11/13. A deficiency will be cited.

Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, Chapter 1 or 6 of the California Code of Regulations.

An exit interview was conducted, where a copy of this report, 9099C, 9099d and appeal rights were reviewed and provided to House Manager Lourdes Pagulayan.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/25/2023 04:51 PM - It Cannot Be Edited

Created By: Javina George On 04/25/2023 at 04:26 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: ALPHA CHRISTIAN HOMES AT REISLING	FACILITY NUMBER: 336425825
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80075(f)

Health-Related Services

(f) Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview and record review, the licensee did not comply with the section cited above in 2 out of 2 times of staff not having renewed their CPR/First Aid certification, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 04/26/2023
	Plan of Correction
1 2 3 4	The Licensee agrees to enroll both identied staff in CPR/FIrstAid training. Proof is to be submitted to the department by 5 pm on the due date indicated.

Type A

Section Cited

HSC

1565(d)

This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	(d) A facility shall review the plan annually and make updates as necessary, including changes in floor plans and the population served. The licensee, administrator, or regulated individual shall sign and date the documentation to indicate that the plan has been reviewed and updated as necessary. This requirement is not met as evidenced by: Based on record review), the licensee did not comply with the section cited above in 1 out of 1 times which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 04/26/2023
	Plan of Correction
1 2 3 4	The Licensee agrees to complete an updated LIC 610D. Proof is to be submitted to the department by 5pm on the due date indicated.

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:

Joel Esquivel

LICENSING EVALUATOR NAME:

Javina George

LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

LIC809 (FAS) - (06/04)

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