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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366425616
Report Date: 03/08/2022
Date Signed: 03/08/2022 10:55:11 AM

Document Has Been Signed on 03/08/2022 10:55 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:COLE VOCATIONAL SERVICES ONTARIO BMPFACILITY NUMBER:
366425616
ADMINISTRATOR:RACHEL STEWARDFACILITY TYPE:
775
ADDRESS:3311 SHELBY STTELEPHONE:
(909) 483-0067
CITY:ONTARIOSTATE: CAZIP CODE:
91764
CAPACITY: 60CENSUS: 14DATE:
03/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Tiffany Jonhston- Day Program ManagerTIME COMPLETED:
11:05 AM
NARRATIVE
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Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the day program to conduct an annual inspection focused on infection control. LPA was greeted and granted entry by Day Program Manager Tiffany Johnston. LPA explained the purpose of the visit. At the time of visit there were 10 staff, and 14 participants present. The day program currently has no positive or suspected Covid-19 cases. The day program opened back up for services on 3/7/2022. Upon entry Tiffany Johnston made LPA aware that the water in the facility is not operating.

During today's visit, LPA toured the day program and made observations regarding the infection control measures that the day program has implemented. The day program has an adequate amount of hand hygiene supplies (soap, hand sanitizer). All staff present were also observed wearing appropriate face coverings. The staff cleans and disinfects multiple times throughout the day, during change of activities, and change of shift.

The day program has a plan in place to monitor participants regularly for any changes in condition, which includes daily temperature checks upon entry and screening questions. Should a consumer begin to exhibit any symptoms related to COVID-19, day program staff will contact the client's responsible party. The consumer will wait in the designated isolation room located in the front conference room until they are able to be picked up from the day program.

Based on the observations made during today’s visit, 1 deficiency was cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and a copy of this report and appeal rights was provided to Tiffany Johnston.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2022
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 03/08/2022 10:55 AM - It Cannot Be Edited


Created By: Ryan Gardner On 03/08/2022 at 10:13 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
, CA 92507

FACILITY NAME: COLE VOCATIONAL SERVICES ONTARIO BMP
FACILITY NUMBER: 366425616

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/08/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82088e(3)


This requirement is not met as evidenced by: the water in the facility is non operational.
Deficient Practice Statement
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Based on interview and observation the licensee did not comply with the section cited above in 1 out of 1 by not having operating water during business hours, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/09/2022
Plan of Correction
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The Day Program Manager will contact the water company and a plumber to fix the water. Upon completion Day Program Manager will send proof of correction.
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:Karen Clemons
LICENSING EVALUATOR NAME:Ryan Gardner
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2022


LIC809 (FAS) - (06/04)
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