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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370803192
Report Date: 09/16/2024
Date Signed: 09/16/2024 02:25:54 PM

Document Has Been Signed on 09/16/2024 02:25 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:ARC OF SAN DIEGO-SOL AND RUTH GERBER FAMILY CENTERFACILITY NUMBER:
370803192
ADMINISTRATOR/
DIRECTOR:		LILIANA DOLBAIAFACILITY TYPE:
775
ADDRESS:1280 NOLAN AVENUETELEPHONE:
(610) 800-3635
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 186CENSUS: 134DATE:
09/16/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Case Manager Patricia Ochoa-Avila and Program Administrator Susana LevackTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to continue a Required Annual Inspection which began on 09-11-2024. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Case Manager Patricia Ochoa-Avila and Program Administrator Susana Levack.

According to the facility’s license, the day program facility has a maximum capacity for one hundred eighty-six (186) clients, of which fifty (50) may be non-ambulatory, but none may be bedridden. Per LPA observation, randomized review of LIC602 Physician’s Reports, and staff interviews: At the commencement of the inspection, there were a total of one hundred thirty-four (134) clients enrolled in the day program in total, of which twenty-seven (27) were non-ambulatory and none were bedridden. The facility’s license does not include endorsements for delayed-egress doors or secured perimeter, and neither of these were present during the inspection.

LPA reviewed records for multiple clients and multiple staff. LPA interviewed multiple clients and staff. LPA, accompanied by Licensee’s staff, also toured the interior and exterior of the facility and inspected all common areas and classrooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Doors, windows, sinks, toilets, and shower were working. Extra hygiene supplies were present. The facility had sufficient space and equipment to facilitate snacks, visitation, meetings, and client activities.

The facility’s ambient internal temperature was complaint at 73 F. Hot water temperature at taps accessible to clients were complaint in temperature: Public Restroom #1 Sink was 112.8 F, Public Restroom #2 Sink was 113.4 F, Public Restroom #3 Sink was 105 F, and Public Restroom #4 Sink was 105 F. Appliances to preserve perishable food were also compliant in temperature: Refrigerators were 40 F, 40 F, 39 F, and 39 F, respectively. Freezers were 0 F and -2 F, respectively. Food that was present was safely stored. [CONTINUED ON LIC 809-C]
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2024
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 09/16/2024 02:25 PM - It Cannot Be Edited


Created By: Dang Nguyen On 09/16/2024 at 12:56 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
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ARC OF SAN DIEGO-SOL AND RUTH GERBER FAMILY CENTER
FACILITY NUMBER: 370803192

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
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
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Based on LPA observation, Licensee did not ensure that disinfectants, cleaning solutions, poisons, and other items which could pose a danger if readily available to clients were stored where inaccessible to clients. This posed an immediate health and safety risk to 134 of 134 clients (C1 through C134) in care.
POC Due Date: 09/16/2024
Plan of Correction
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During the annual inspection, LPA handed these items to day program staff, who immediately secured/locked them. This resolved the immediate risk. Licensee agreed to conduct an in-service meeting to retrain staff on what items can become hazardous in the hands of clients, and the importance of keeping them locked/secured. Licensee agreed to E-mail a copy of the training sign-in sheet to LPA, by 10-16-2024.
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:Lizzette Tellez
LICENSING EVALUATOR NAME:Dang Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 09/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/16/2024 02:25 PM - It Cannot Be Edited


Created By: Dang Nguyen On 09/16/2024 at 01:20 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
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ARC OF SAN DIEGO-SOL AND RUTH GERBER FAMILY CENTER
FACILITY NUMBER: 370803192

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80072(a)(8)(F)(1)
80072 Personal Rights: “(a) …each client shall have personal rights which include, but are not limited to, the following: (8) Not to be placed in any restraining device... (F)…Protective devices may be used if they are approved in advance by the licensing agency as specified below. 1. All requests to use protective devices shall be in writing and include a written order of a physician indicating the need for such devices.”

This requirement was not met as evidenced by:
Deficient Practice Statement
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For 1 of 186 clients (C1), who used a helmet protective device at program, Licensee did not obtain a written order from the physician and advance approval from the licensing agency for said device. This posed a potential personal rights risk to persons in care.
POC Due Date: 10/16/2024
Plan of Correction
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Licensee agreed to coordinate with the C1’s physician to obtain a written order indicating their need to wear a helmet. License then agreed to E-mail an Exception Request letter, with said physician’s order, latest LIC602 Physician's Report, and letters of endorsement from C1’s responsible person and San Diego Regional Center (SDRC) coordinator, to the CCLD San Diego Regional Office (CCLASCPSanDiegoRO@dss.ca.gov), and to CC LPA Nguyen (dang.nguyen@dss.ca.gov), by the POC due date.
Type B
Section Cited
CCR
80072(a)(8)(B)
80072 Personal Rights: “(a) …each client shall have personal rights which include, but are not limited to, the following: (8) Not to be placed in any restraining device. Postural supports may be used under the following conditions: (B) A written order from the client's physician indicating the need for the postural support shall be maintained in the client's record…”

This requirement was not met as evidenced by:
Deficient Practice Statement
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This requirement was not met, as evidenced by: For 16 of 186 clients (C2 through C17), Licensee did not maintain a written order from the client’s physician indicating the need for the postural support in the client’s record of care. This posed a potential personal rights risk to persons in care.
POC Due Date: 10/16/2024
Plan of Correction
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For C2 through C19 each: Licensee agreed to coordinate with the clients’ physician to obtain a written order indicating the clients’ need for their wheelchair seatbelt. License then agreed to E-mail an individual Exception Request letter, with physician’s order and latest LIC602 Physician's Report, for each client’s wheelchair seatbelt to the CCLD San Diego Regional Office (CCLASCPSanDiegoRO@dss.ca.gov), and to CC LPA Nguyen (dang.nguyen@dss.ca.gov), by the 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:Lizzette Tellez
LICENSING EVALUATOR NAME:Dang Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 09/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2024


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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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: ARC OF SAN DIEGO-SOL AND RUTH GERBER FAMILY CENTER
FACILITY NUMBER: 370803192
VISIT DATE: 09/16/2024
NARRATIVE
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[CONTINUED FROM LIC 809] Medications were labeled, as required, and stored in locked areas. Confidential records were stored in locked areas. No pools or bodies of water were observed on the premises. There were no fireplaces or open-faced heaters present.

Required licensing postings were observed in visible areas of the facility. Fire/disaster drills were performed at required intervals. A complete first aid kit and supplies of Personal Protective Equipment (PPE) were present. Per the Licensee, no firearms or ammunition are kept at the facility. Fire detection system, carbon monoxide detector, emergency lighting, and facility telephone were all working. The facility’s fire extinguishers were serviced within the last twelve (12) months.

LPA observed hazardous items inside classrooms which were not stored inaccessible to clients (and clients were present): Fourteen (14) long scissors, one (1) box cutter with blade, one (1) metal screwdriver, one (1) metal gardening hand spade, one (1) metal-tipped full-length gardening hoe, five (5) gallons of alcohol-based antiseptic, five (5) small bottles of nail polish, three (3) bottles of peroxide-based cleaning chemical, and two (2) additional bottles of chemicals. LPA handed these items to day program staff, who immediately secured/locked them.

During records review, LPA observed, and manager interview confirmed: Client #1 (C1) wore a helmet (i.e., a “protective device”) at program, but Licensee did not possess a written order from C1’s physician for it and had not prior secured CCLD approval for this device, as was required. Client #2 (C2) through Client #17 (C17) used wheelchair seat belts (i.e., “postural supports”), but Licensee did not possess a written order from the client’s physicians indicating the need for such wheelchair seat belts.

Three (3) deficiencies were cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D pages). Plans of Correction were jointly developed with the Licensee. LPA also issued Technical Assistance (TA) regarding adding additional carbon monoxide detectors (refer to the attached LIC 9102-TA page).

An exit interview was conducted with Levack, to whom a copy of this report, the LIC 809-D pages, the LIC9102-TA page, the LIC811 Confidential Names List pages, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today’s visit.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
LIC809 (FAS) - (06/04)
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