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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361800189
Report Date: 08/14/2024
Date Signed: 08/14/2024 12:33:47 PM

Document Has Been Signed on 08/14/2024 12:33 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:VALLEY STAR CRISIS RES. TREATMENT- DESERT HILLFACILITY NUMBER:
361800189
ADMINISTRATOR/
DIRECTOR:		SYLVIA RODRIGUEZFACILITY TYPE:
772
ADDRESS:16552 SUNHILL DRIVETELEPHONE:
(760) 780-4400
CITY:VICTORVILLESTATE: CAZIP CODE:
92395
CAPACITY: 16CENSUS: 15DATE:
08/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Kelly Larsen- StaffTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Michelle Echeverria, Lavette Farlow and Becky Mann arrived unannounced to conduct the required annual visit to the facility. LPAs met with staff, Kelly Larsen and introduced self and stated the purpose of the visit. LPAs were informed that there are currently 15 clients in care in the facility.

The facility has 11 client bedrooms, 6 bathrooms, offices plus staff bathrooms, kitchen, pantry, dining area, quiet room, nurses room with offices, medication room, client storage room, interview room, security room, web area, emergency supply room, family room, entertainment room, laundry room, linen room, electrical storage room and shaded patio. LPAs completed a walk through of facility, review of records, and medication audit.

Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 72.7 degrees Fahrenheit. LPAs inspected client bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPAs inspected client bathrooms; bathrooms appliances were found functional. Water temperatures tested at 107 degrees fahrenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms and charged fire extinguishers. Posters such as; the personal rights, visitors rules, and CCL complaint poster were posted in a common area. Cleaning supplies, toxins, sharps and other dangerous items were kept secure locked and inaccessible to clients. Clients/staff files are kept locked inside the office. Medications and first aid kits were observed locked and inaccessible to clients. LPAs observed plenty of towels, linens and comforters in the linen room. There are no firearms, ammunition, swimming pool or bodies of water in the facility. Overall, the facility is in good repair, and operating in safe conditions for clients in care.

Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care. Facility has a wide variety of food available. Dishes, cups, and utensils were also stored properly. Emergency food and water were also observed.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2024
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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Document Has Been Signed on 08/14/2024 12:33 PM - It Cannot Be Edited


Created By: Michelle Echeverria On 08/14/2024 at 11:48 AM
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 STAR CRISIS RES. TREATMENT- DESERT HILL
FACILITY NUMBER: 361800189

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
81070(b)(9)
Client Records
(b) Each client record shall contain the following information including, but not limited to, the following: (9) Medical assessment, including ambulatory status, as specified in Section 81069.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the program director did not comply with the section cited above in including ambulatory status in 4 client records which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/30/2024
Plan of Correction
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Program Director stated that she will submit proof of the 4 client records ambulatory status to LPA via email by POC due date.
Type B
Section Cited
CCR
81075(b)
Health-Related Services
(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the program director did not comply with the section cited above in making sure that the client was assisted as needed with their medication which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/30/2024
Plan of Correction
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Program Director stated that she will host a training with staff on the regulation cited and submit proof of attendance to LPA via email 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:Nedra Brown
LICENSING EVALUATOR NAME:Michelle Echeverria
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/14/2024 12:33 PM - It Cannot Be Edited


Created By: Michelle Echeverria On 08/14/2024 at 11:48 AM
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 STAR CRISIS RES. TREATMENT- DESERT HILL
FACILITY NUMBER: 361800189

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1565(c)
Other Provisions
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of individuals served by the facility is not required during a drill. While a facility may provide an opportunity for individuals served by the facility to participate in a drill, it shall not require that participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and, if applicable, the names of staff participating in the drill.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview and record review, the program director did not comply with the section cited above in conducting an emergency drill quarterly which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/30/2024
Plan of Correction
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Program Director stated that she will review the regulation cited and submit a statement of understanding along with proof of a drill conducted to LPA via email by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Nedra Brown
LICENSING EVALUATOR NAME:Michelle Echeverria
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2024


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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: VALLEY STAR CRISIS RES. TREATMENT- DESERT HILL
FACILITY NUMBER: 361800189
VISIT DATE: 08/14/2024
NARRATIVE
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Yards/Outside: One shaded patio, a side gate on the left and right side of the facility. All outdoor pathways were free of obstructions.

Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department.

Record Review: LPAs reviewed client files for admission agreements, updated physician reports, and needs and services. LPAs observed that 4 client records did not have ambulatory status. Deficiency issued. LPAs also reviewed staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. Medications were audited at random and appeared to not be dispensed appropriately by staff. LPA observed that one client was not administered medication since the medication was left in the bubble pack and signed off on the medication record as dispensed. Deficiency issued. LPAs observed that the emergency disaster plan was not reviewed/updated since 6/26/23. Technical violation issued. LPAs observed that the facility conducted an emergency disaster drill on 9/30/23. Deficiency issued.

Deficiencies and one technical violation were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC809D, LIC9102TV and appeal rights were discussed and copies were provided to Program Director, Sylvia Rodriguez who later arrived.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
LIC809 (FAS) - (06/04)
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