<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366402294
Report Date: 09/05/2024
Date Signed: 09/05/2024 11:57:15 AM

Document Has Been Signed on 09/05/2024 11:57 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:COLE VOCATIONAL SERVICES VICTORVILLEFACILITY NUMBER:
366402294
ADMINISTRATOR/
DIRECTOR:		COX, BRANDONFACILITY TYPE:
775
ADDRESS:16519 VICTOR STTELEPHONE:
(760) 962-9111
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY: 120CENSUS: 117DATE:
09/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Brandon Cox-AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:05 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 Analysts (LPAs) Michelle Echeverria and Renese Howell-Small conducted an unannounced required Annual Inspection. LPAs identified themselves to staff, Delfina Hernandez and Administrator, Brandon Cox who were advised of the purpose of the visit. The facility is currently licensed as an Adult Day Program and has 117 clients admitted. LPAs were accompanied by Brandon Cox to conduct a general overall inspection, which included, but was not limited to, the following:

LPAs inspected the facility inside. LPAs observed all passageways are clear of obstructions. The facility is maintained at a comfortable temperature of 75, 76, 74 and 73 degrees fahrenheit. LPAs inspected client activity rooms; they are equipped with required furniture and activity supplies/equipment for clients. LPAs inspected client bathrooms; bathroom appliances were operating in good conditions. LPAs observed grab bars in the bathrooms. LPAs observed accessible cleaning solutions left inside the bathroom and beneath a sink in the activity room. Deficiency issued. LPAs observed sufficient furniture and lighting throughout the facility. The hot water temperature tested within regulation at 116.8 degrees fahrenheit. Sharps were locked and inaccessible to clients. There are no firearms/ammunition or bodies of water. LPAs observed a broken kitchen cabinet, broken soap dispenser inside the bathroom, dirty bathroom wall, and broken gardening closet door. Deficiency issued.

At Day Program, clients are responsible to bring their own lunch. Snacks were accessible to clients and stored in a healthful manner. LPAs observed the kitchen area to be clean, free of odors, and in a healthful manner.

LPAs observed sufficient staff present for the number of clients in care. Medication is not stored in the facility. LPAs observed fire extinguishers, smoke alarms, carbon monoxide alarms, and first aid kit in the facility. The last disaster drill was conducted on 7/9/24.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Michelle Echeverria
LICENSING EVALUATOR SIGNATURE: DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
Document Has Been Signed on 09/05/2024 11:57 AM - It Cannot Be Edited


Created By: Michelle Echeverria On 09/05/2024 at 11:07 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: COLE VOCATIONAL SERVICES VICTORVILLE
FACILITY NUMBER: 366402294

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82087(a)
Buildings and Grounds
(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the administrator did not comply with the section cited above in maintaining the facility clean, safe, sanitary and in good repair which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/12/2024
Plan of Correction
1
2
3
4
Administrator stated that he will correct the following issues: broken kitchen cabinet, broken soap dispenser inside the bathroom, dirty bathroom wall, and broken gardening closet door. Administrator that he will send pictures of corrections to LPA via email by POC due date.
Type B
Section Cited
CCR
82087(a)(3)
Buildings and Grounds
(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (3) Disinfectants, cleaning solutions, poisons, and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the administrator did not comply with the section cited above in making cleaning solutions inaccessible which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/12/2024
Plan of Correction
1
2
3
4
Administrator stated that he will train staff on regulation cited and submit a copy of attendance sheet 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: 09/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2024


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 09/05/2024 11:57 AM - It Cannot Be Edited


Created By: Michelle Echeverria On 09/05/2024 at 11:07 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: COLE VOCATIONAL SERVICES VICTORVILLE
FACILITY NUMBER: 366402294

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82068.2(d)(1)
Needs and Services Plan
(d) If the client has an existing needs appraisal or individual program plan (IPP) completed by a placement agency, or a consultant for the placement agency, the Department may consider the plan to meet the requirements of this section provided that: (1) The needs appraisal or IPP is not more than one year old.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
 Based on observation and record review, the administrator did not comply with the section cited above in reviewing and updating the clients needs appraisals/IPP which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/12/2024
Plan of Correction
1
2
3
4
Administrator stated that he will update the clients needs appraisals/IPP and submit a statement of understanding on regulation cited to LPA via email by POC due date.
Type B
Section Cited
CCR
82023(b)
Disaster and Mass Casualty Plan
(b) The plan shall be subject to review by the licensing agency and shall include:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the administrator did not comply with the section cited above in reviewing/updating the Emergency Disaster Plan which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/12/2024
Plan of Correction
1
2
3
4
Administrator stated that he will review and update the emergency disaster plan and send a copy 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: 09/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/05/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
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: COLE VOCATIONAL SERVICES VICTORVILLE
FACILITY NUMBER: 366402294
VISIT DATE: 09/05/2024
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
26
27
28
29
30
31
32
LPAs reviewed client files for admission agreements, updated physician reports, and needs and services plans. LPAs observed that many client files had an expired IPP/needs appraisal. Deficiency issued. LPAs also reviewed staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPAs observed that the Emergency Disaster Plan was not reviewed/updated since 1/27/22. Deficiency issued.

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

An exit interview was conducted, and this report LIC809, LIC809C, LIC809D and appeal rights were discussed and provided to Administrator, Brandon Cox.

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

DATE: 09/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2024
LIC809 (FAS) - (06/04)
Page: 4 of 4