370808454-4-29-2024-08-AS-LSIA-D4T4X4-20240429192854

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 370808454
Report Date: 04/23/2024
Date Signed: 04/29/2024 07:38:44 PM

Document Has Been Signed on 04/29/2024 07:38 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:	HALCYON CENTER		FACILITY NUMBER:	370808454
ADMINISTRATOR/ DIRECTOR:	PRISCILLA GROSSMAN		FACILITY TYPE:	772
ADDRESS:	1664 BROADWAY		TELEPHONE:	(619) 579-8685
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92021
CAPACITY: 14		CENSUS: 11	DATE:	04/23/2024
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:00 PM
MET WITH:	Director Priscilla Grossman and Assistant Director Cassidy Pacheco		TIME VISIT/ INSPECTION COMPLETED:	03:30 PM

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Licensing Program Analysts (LPA) Liliana Silveira conducted an unannounced visit to continue a required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Assistant Director Cassidy Pacheco. LPA also spoke to Director Priscilla Grossman.

According to the facility’s license, the facility has a maximum capacity of 14 clients, ages 18-49 years, five of whom may be non-ambulatory. Facility is also approved for insulin dependent diabetics. During today’s inspection, there were a total of 11 clients in care, and per medical records, all were ambulatory. This facility does not feature a secured perimeter or delayed egress doors.

LPA interviewed multiple staff and clients. LPA reviewed multiple staff and client records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained required documents. Confidential records were stored in locked areas. Priscilla also presented proof of current/active business liability insurance.

No pools or bodies of water were observed on the premises. Per Director Priscilla Grossman, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas.

LPA, accompanied by Priscilla, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. (continued on next page, LIC 809-C)

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

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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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: HALCYON CENTER	FACILITY NUMBER: 370808454
	VISIT DATE: 04/23/2024

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Doors, windows and screens, toilets, 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 74 F.

During the walk through inspection, LPA observed that in 1 out of 7 bedrooms, there were dresser drawers that were broken and non-operable. Director Priscilla Grossman stated that a handyman recently attempted to fix them but was not able to. The facility is currently trying to purchase new dresser drawers.

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. During the kitchen inspection, LPA observed a food item that was spoiled. Priscilla stated that the facility receives donated foods two times per week and are currently implementing a better system for checking the condition of the foods when received.

Two deficiencies were cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D). A Plan of Correction was jointly developed with the licensee. An exit interview was conducted with Priscilla, to whom a copy of this report, the LIC 809-D, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/29/2024 07:38 PM - It Cannot Be Edited

Created By: Liliana Silveira On 04/23/2024 at 03:19 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: HALCYON CENTER	FACILITY NUMBER: 370808454
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/23/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

81088

Fixtures, Furniture, Equipment, and Supplies: (i) The licensee shall ensure provision to each client of the following furniture, equipment and supplies necessary for personal care and maintenance of personal hygiene. (3) Permanent or portable closets and drawer space in each bedroom to accommodate the client's clothing and personal belongings. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	This requirement was not met, as evidenced by: Based on LPA observations, a dresser drawer was out of order for 2 clients in care, which posed a potential safety risk to persons in care.
	POC Due Date: 05/23/2024
	Plan of Correction
1 2 3 4	Director stated that they are currently looking for new furniture to purchase. The Director will contact LPA once it is ready.

Type B

Section Cited

CCR

81076

81076 Food Service (a) In a social rehabilitation facility providing meals to clients, the following shall apply: (1) All food shall be safe and of the quality and in the quantity necessary to meet the needs of the clients. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	This requirement was not met, as evidenced by: Based on LPA observations, a package a spoiled food was found in a cupboard, which posed a potential safety risk to 11 persons in care.
	POC Due Date: 05/23/2024
	Plan of Correction
1 2 3 4	Director indicated that effective immediately, you are implementing a a daily check system for all incoming food. Facility will have a checklist to check off.

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:

Jennifer Lott

LICENSING EVALUATOR NAME:

Liliana Silveira

LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2024

LIC809 (FAS) - (06/04)

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