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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361800141
Report Date: 06/12/2023
Date Signed: 06/12/2023 10:46:13 AM

Document Has Been Signed on 06/12/2023 10:46 AM - 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
, CA 92507
FACILITY NAME:FIRST STEP INDEPENDENT LIVING INCFACILITY NUMBER:
361800141
ADMINISTRATOR:SLAUGHTER, LANAIRFACILITY TYPE:
775
ADDRESS:3654 HIGHLAND AVE STE 17TELEPHONE:
(909) 483-2505
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY: 75CENSUS: DATE:
06/12/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Marcia Ramos - Program ManagerTIME COMPLETED:
10:48 AM
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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced case management visit to this facility regarding an incident report received by CCL Regional Office. LPA met with day program manager Marcia Ramos who was informed of the reason for today's visit.

On 6/5/2023, CCL Regional Office received an incident report that stated violation of client (C1) rights. The report noted that Staff 1 (S1) found C1 with briefs that were not included in C1's physician's order. S1 informed Staff 2 (S2) that C1's briefs should be removed and S2 stated that they did not want C1 to have an accident on their way home.

During today's visit, it was discovered that S2 had been placed on unpaid administrative leave. Records reviewed show that S2 received training on abuse reporting and clients' rights in the first quarter of 2023. Staff interviews revealed that there was cause for C1 needing briefs, however this was a temporary change in condition from the last quarter of 2022. C1 resides in a facility that requires a higher level of care.

No deficiencies were observed during today's visit. A technical advisory was issued to remind staff of the importance of maintaining an accurate record of the client's needs and services however temporary. A copy of this report was reviewed with and provided to Marcia Ramos at the conclusion of this visit.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2023
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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