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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366427604
Report Date: 05/31/2022
Date Signed: 06/21/2022 02:45:21 PM

Document Has Been Signed on 06/21/2022 02:45 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:COLE VOCATIONAL SERVICES HESPERIAFACILITY NUMBER:
366427604
ADMINISTRATOR:BAGLEY, KIMBERLYFACILITY TYPE:
775
ADDRESS:15075 MAIN STTELEPHONE:
(760) 998-2829
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY: 75CENSUS: 17DATE:
05/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:57 PM
MET WITH:Simien Hires, Program DirectorTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA ) Rayshaun Nickolas conducted an unannounced visit to the facility. The purpose of the visit was to conduct a required annual inspection, with an emphasis on infection control due to the COVID-19 pandemic. LPA Nickolas arrived and met with Program Director, Simien Hires. LPA Nickolas was asked to sign-in and provide temperature reading upon arrival. The Program Director confirmed that there are currently no cases/exposures of COVID-19 within the facility.

During the inspection, LPA Nickolas conducted a tour of the facility and made observations pertaining to the facility's infection control measures and other health and safety concerns. LPA Nickolas observed appropriate postings throughout the facility, including hand-washing etiquette, face coverings, and COVID-19 symptoms postings. The facility was also equipped with sufficient hand hygiene supplies, sufficient cleaning/disinfecting provisions, and a supply of Personal Protective Equipment (PPE). LPA observed that the facility staff were wearing face coverings. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the facility's infection control measures. The facility has a plan in place which follows Community Care Licensing Division (CCLD) guidelines for COVID-19 testing, isolating/quarantining clients, and properly caring for clients with COVID-19 positive results and/or exposures. The facility also has a plan in place to monitor clients regularly for any changes in condition and to subsequently notify the clients physician and emergency personnel in the event the clients presents any COVID-19 symptoms.

LPA observed no apparent health and safety concerns at the time of visit. An exit interview was conducted where this report was discussed, and a copy of this report was provided to Hires at the conclusion of the inspection.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2022
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 06/27/2022 11:06 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 06/01/2022 10:32 AM


Created By: Rayshaun Nickolas On 05/31/2022 at 03:11 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: COLE VOCATIONAL SERVICES HESPERIA
FACILITY NUMBER: 366427604

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/31/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82019(e)
82019 Criminal Records Clearance (e)
Prior to working, residing or volunteering in a licensed day program, all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall do the following:
(1) Obtain a California clearance or a criminal record exemption as required by the Department; or
(2) Request the licensee or applicant for a license to request a transfer of a criminal record clearance as specified in Section 82019(f); or ...
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above by not ensuring
(S1) was associated to the facility prior to working. LPA observed that S1 had a criminal records clearance but not associated to the facility. Which poses an immediate health and safety risk to persons in care. A civil penalty in the amount of $500.00 was assessed on 05/31/2022.
POC Due Date: 06/01/2022
Plan of Correction
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The licensee shall associate S1 to the facility on guardian. Liceensee shall submit administrator packet for S1 to the Regional Office. Licensee shall submit proof of correction to LPA on June 1, 2022, by the close of business.
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:Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2022


LIC809 (FAS) - (06/04)
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