370801896-10-26-2023-08-AS-AROS-CWYVZ6-20231026165215

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 370801896
Report Date: 10/26/2023
Date Signed: 10/26/2023 04:52:26 PM

Document Has Been Signed on 10/26/2023 04:52 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 DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	VOA - TROY CENTER FOR SUPPORTIVE LIVING		FACILITY NUMBER:	370801896
ADMINISTRATOR:	NICHOLAS FIERRO		FACILITY TYPE:	735
ADDRESS:	8627 TROY STREET		TELEPHONE:	(619) 465-8792
CITY:	SPRING VALLEY	STATE: CA	ZIP CODE:	91977
CAPACITY:	40	CENSUS: 39	DATE:	10/26/2023
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Licensee, Nicolas Fierro		TIME COMPLETED:	04:30 PM

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Licensing Program Analyst (LPA’s) Amy Rodgers conducted an unannounced Required Annual Inspection to ensure substantial compliance with Title 22 regulations. The facility file was reviewed prior to the visit. LPA’s were welcomed by, identified themselves to, and discussed the purpose of the visit with Administrator, Nicolas Fierro.

According to the facility’s license, the facility has a maximum capacity of forty (40) residents, all of which are ambulatory. During today’s inspection, there were a total of 40 clients in care. This facility does not feature a secured perimeter or delayed egress doors.

LPA, accompanied by Administrator, Nicolas Fierro. toured the interior and exterior of the facility, and inspected each room. The facility was adequately clean, sanitary, and in sufficient condition. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was compliant. Hot water temperature at taps accessible to clients were all compliant.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There is a separate locked kitchen on site. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas.

[CONTINUED ON LIC 809-C]

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

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 DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: VOA - TROY CENTER FOR SUPPORTIVE LIVING	FACILITY NUMBER: 370801896
	VISIT DATE: 10/26/2023

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[CONTINUED FROM LIC 809]

No pools or bodies of water on the premises. Per Administrator, Nicolas Fierro, no firearms or ammunition are kept at the facility. The site has a working signal system. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were in working order. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA interviewed staff and clients. LPA interviews did not raise any licensing concerns. LPA reviewed multiple staff and client records/files. Files reviewed contained required documents. Confidential records were stored in locked areas. Administrator, Nicolas Fierro presented proof of current/active business liability insurance. LPA observed that residents were being treated with dignity by staff during medication distribution, and there were sufficient staff on duty to meet resident’s needs

An exit interview was conducted with Administrator, Nicolas Fierro whom copies of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 10/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023

LIC809 (FAS) - (06/04)

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