366401946-11-27-2023-56-AS-ACON-CXYV99-20231127151358

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 366401946
Report Date: 11/27/2023
Date Signed: 11/27/2023 03:14:08 PM

Document Has Been Signed on 11/27/2023 03:14 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:	OPARC ADULT DEVELOPMENT CENTER-MONTCLAIR		FACILITY NUMBER:	366401946
ADMINISTRATOR:	BARBARA CHAVEZ		FACILITY TYPE:	775
ADDRESS:	4650 ARROW HWY. SUITE G15-21		TELEPHONE:	(909) 625-0213
CITY:	MONTCLAIR	STATE: CA	ZIP CODE:	91763
CAPACITY: 70		CENSUS:	DATE:	11/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Barbara Chavez, Program Manager & Susan Hernandez, Asst. Program Mgr.		TIME COMPLETED:	03:25 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst, Amber Coleman, (LPA) arrived at the OPARC Adult Development Center – Montclair unannounced to conduct the facility’s Annual Inspection. LPA walked in, introduced self and stated the purpose of the visit. LPA met with both Susan Hernandez, Assistant Program Director and Barbara Chavez, Program Manager (Administrator) and was provided with a space to work. The reported census is 40, with 10 staff members present at the time of the visit. The facility is comprised of five bathrooms, changing room, several multipurpose rooms, kitchen, and several offices for staff use. The facility was initially licensed in November of 1997; approved capacity 70. 30 non-ambulatory and 40 ambulatory individuals. The facility also maintains vendorship with Inland Regional Center, (IRC) Accompanied by Day Program Manager, Barbara Chavez, LPA completed a walk through of the facility and observed the following: Physical Plant: Pathways inside and outside the facility were clear of obstructions and clutter. Facility was maintained in comfortable temperature throughout the building. There are fire extinguishers posted in various places throughout the facility. All fire extinguishers were last inspected November 1^st, 2023. Day Program Manager reported the facility conducts fire and disaster drills monthly. The last disaster drill was completed prior to LPA arrival 11/27/23. Evacuation Maps were posted in prominent places throughout the facility. LPA also observed complete first aid kits also posted in an easily accessible area. LPA observed five restrooms; which all contained adequate amounts of hand hygiene and paper supplies. Each restroom included secure cabinets which contained incontinent supplies. LPA tested water temperature in the kitchen and changing room. Water temperature was measured between 102 degrees and 115 degrees Fahrenheit; within regulatory limits. LPA observed informational posters for resident rights, labor laws LET-US-KNOW, designated Administrator, Infection Control and licensing forms posted near the facility’s front entrance.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:	DATE: 11/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023

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

FACILITY NAME: OPARC ADULT DEVELOPMENT CENTER-MONTCLAIR	FACILITY NUMBER: 366401946
	VISIT DATE: 11/27/2023

NARRATIVE

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All cleaning supplies, toxins, sharps, and other dangerous items were observed in secure locations and inaccessible to individuals in care. Assistant Program Manager reported that the facility does provide medication management services to one individual in care at this time. LPA observed that the medications and records were located in a secure area inaccessible to unauthorized persons.

Food Service: LPA was informed that the facility provides snacks to its individuals in care. LPA observed two refrigerators stocked with adequate amounts of snacks such as beverages, pudding, dry snacks and frozen foods. These maybe provided to those who may have forgot their meal or individuals who may want additional food. The facilities kitchen was observed to be orderly and equipped with sufficient amounts of dishes and utensils.

Records: LPA reviewed individual files for admission agreements, updated medical assessment, individual program plans and needs and services plans and found that all individuals’ records included documentation per regulation requirements. LPA located three individuals’ charts which contained outdated Physician’s Reports. LPA reviewed staff files and found that each contained up to date First Aid/CPR certification, criminal/fingerprint/backgrounds record clearances, training, and health screenings per regulation. Overall, LPA observed that the facility is neat, orderly, in good repair, and operating in safe conditions for residents in care.
Based on observations, interviews and record reviews, a deficiency will be cited per Title 22, California Code of Regulations to address the individuals’ medical assessments. A copy of this report was read/reviewed by Facility Representative; signature acknowledges understanding and receipt of report and attachments.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:	DATE: 11/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/27/2023 03:14 PM - It Cannot Be Edited

Created By: Amber Coleman On 11/27/2023 at 03:03 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: OPARC ADULT DEVELOPMENT CENTER-MONTCLAIR	FACILITY NUMBER: 366401946
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/27/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

82068.2(f)(1)(B)

Needs and Services Plan

(f) The completed Needs and Services Plan shall include: (1) The client's desires and background and formal supports, obtained from the client's family or his/her authorized representative, if any, regarding the following: (B) A written medical assessment including primary physician, health problems and medical history, prescribed medications and their strength, quantity, frequency required and purpose as specified in Section 82069(b)(3). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on review of records the licensee did not comply with the section cited above by not confirming that three individuals in care had files that contained up to date medical assessments which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/27/2023
	Plan of Correction
1 2 3 4	Program Manager/Administrator agrees to contact the individuals care providers and request that they submit an updated LIC602(Physician's Report) to keep in their files at the facility. Program Manager/Administrator also agrees to have the document completed and submit verfication to the Community Care Licensing Office within the next 30 business days.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Amber Coleman

LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023

LIC809 (FAS) - (06/04)

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