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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366426169
Report Date: 08/01/2023
Date Signed: 08/02/2023 08:12:55 AM

Document Has Been Signed on 08/02/2023 08:12 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
LA & TRI-COASTAL CR, 1000 CORPORATE CNTR DR. #200A
MONTEREY PARK, CA 91754
FACILITY NAME:A POSITIVE ATTITUDE OUTLOOK OF SOUTHERN CALIFORNIAFACILITY NUMBER:
366426169
ADMINISTRATOR:R.MCGEE & S. YONANFACILITY TYPE:
430
ADDRESS:8632 ARCHIBALD SUITE 103TELEPHONE:
(909) 466-4023
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY: 8CENSUS: 5DATE:
08/01/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Kitty Thompson - Supervising Social WorkerTIME COMPLETED:
03:30 PM
NARRATIVE
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On August 1st, 2023 at 10:00AM Licensing Program Analyst (LPA) Ashley Ruacho conducted an unannounced inspection at the above facility for the purpose of continuing an annual/required inspection. LPA met with Supervising Social Worker, Kitty Thompson.

On the initial inspection date LPA observed that the JV 223 for C1 was expired and the Foster Family Agency (FFA) was unable to provide proof of updated order. A citation will be issued for the expired document.

LPA selected five (05) staff files for this review. All staff have the verification of Department of Justice, Federal Bureau of Investigations, and Child Abuse Index Check clearances. All five (05) staff met the required education and experience and the FFA is operating within the social worker/client ratio.

LPA selected five (05) Resource Family Home files for this review. All five (05) records reviewed have the verification of Department of Justice, Federal Bureau of Investigations and Child Abuse Index Check clearances. LPA observed that all written reports were not signed by the perspective resource parent. A citation will be issued for the missing signatures.

An exit interview was conducted and a copy of this report, LIC 809D, the LIC 811 (Confidential Names List) and the appeal rights were given and explained to the facility representative.

SUPERVISORS NAME: Tira Logan
LICENSING EVALUATOR NAME: Ashley Ruacho
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2023
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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Document Has Been Signed on 08/02/2023 08:12 AM - It Cannot Be Edited


Created By: Ashley Ruacho On 08/01/2023 at 02:47 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
, 1000 CORPORATE CNTR DR. #200A
MONTEREY PARK, CA 91754

FACILITY NAME: A POSITIVE ATTITUDE OUTLOOK OF SOUTHERN CALIFORNIA
FACILITY NUMBER: 366426169

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
ILS
88270(a)(4)
Children's Case Records
(a) In addition to California Code of Regulations, Title 22, Section 88070, the following information regarding a child shall be obtained and maintained in the child’s case record by a foster family agency: (4) A copy of the current court order, or written authorization of the child’s parent or guardian, for each psychotropic medication prescribed to the child.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in one out of five client files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/15/2023
Plan of Correction
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Supervising Social Worker will contact County Social Worker for update JV 223
Supervising Social Worker will email updated JV 223 to LPA once recieved
Type B
Section Cited
ILS
88331.7(h)(3)
Written Report
(h) A Written Report shall contain the following: (3) An applicant’s signature acknowledging receipt of the Written Report

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in five out of five Resource Family Home files which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/15/2023
Plan of Correction
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All signature will be obatined by the resource parents
LPA will be emailed when all resource parents have signed
All future resource parents written reports will be signed
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:Tira Logan
LICENSING EVALUATOR NAME:Ashley Ruacho
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2023


LIC809 (FAS) - (06/04)
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