372002856-2-26-2024-18-AS-JSRS-D2TTUS-20240226140248

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 372002856
Report Date: 02/26/2024
Date Signed: 02/26/2024 02:02:58 PM

Document Has Been Signed on 02/26/2024 02:02 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
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	SAN DIEGO BRAIN INJURY FOUND.-HOWARD HOUSE		FACILITY NUMBER:	372002856
ADMINISTRATOR:	FLORETTA CRENSHAW		FACILITY TYPE:	735
ADDRESS:	2033 ORO VERDE ROAD		TELEPHONE:	(760) 480-7468
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92027
CAPACITY: 8		CENSUS: 7	DATE:	02/26/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Patty Ornelas, Administrator		TIME COMPLETED:	02:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Jacqueline Shaw Ross made an unannounced visit to the facility to conduct an annual licensing inspection. LPA was met by Brianda Munoz, Assistant Administrator and was granted entry into the facility. Administrator Patty Ornelas arrived shortly. A tour of the facility was conducted inside and out. Present in the facility were seven (7) residents and three (3) staff. LPA conducted interviews. The facility is a eight (8) bedroom, six (6) bathroom, tri-level home. LPA, accompanied by Administrator Patty conducted a general overall inspection, which included but was not limited to the following: Facility physical plant, food service, medication management, record review and facility administration. During today's inspection, LPA observed the following: Indoor and outdoor passageways were observed to be free from obstruction. There is a swimming pool that has a locked gate latch that is not in use. Per Administrator, there are no firearms or other dangerous weapons in the facility. Poisons and cleaning agents were observed to be secured and inaccessible to residents in care. Facility fire clearance is maintained in conformity with State Fire Marshal regulations. LPA toured every room in the facility. Rooms designated as resident rooms had the required furnishings and sufficient lighting available. Licensee provided each resident with clean linen, in good repair, and sufficient hygiene products for personal use. The hot water temperature measured at 120 degrees F. The facility had a functioning carbon monoxide detector, multiple smoke detectors, and multiple fire extinguisher. The next emergency drill is scheduled for next month. The facility was stocked with a two-day supply of perishable food items and a seven-day supply of nonperishable food items. Staff records were reviewed and contained CPR/First Aid training, Health Screening Reports, and annual training.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SAN DIEGO BRAIN INJURY FOUND.-HOWARD HOUSE	FACILITY NUMBER: 372002856
	VISIT DATE: 02/26/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Resident records were reviewed and had a current Physician's Report, Resident Appraisal, Identification and Emergency Information, Admission Agreement, and Centrally Stored Medication and Destruction Records. Medications were stored in a locked medication cart and were labeled and maintained in compliance with label instructions.

During the tour the following deficiencies were observed:

-LPA observed a cabinet door in the kitchen was broken off the hinges. LPA was informed this happened recently by accident by a client is in the process of getting repaired.

-LPA observed a broken shower handle in one of the bathrooms. LPA was informed it was in the process of getting repaired.

-LPA observed mold under the kitchen sink.

-LPA observed mold on the ceiling of one of the bathrooms.

-LPA observed loose and broken flooring throughout the facility. LPA was informed that the facility is in the process of replacing all flooring.

Citations were issued for the above deficiencies.

An exit interview was conducted and a copy of this report along with a LIC809D, Appeal Rights, and LIC811 was provided to Administrator Patty Ornelas.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

LIC809 (FAS) - (06/04)

Page: 2 of 3

Document Has Been Signed on 02/26/2024 02:02 PM - It Cannot Be Edited

Created By: Jacqueline Shaw Ross On 02/26/2024 at 01:33 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
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SAN DIEGO BRAIN INJURY FOUND.-HOWARD HOUSE	FACILITY NUMBER: 372002856
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80087(a)

Building and Grounds

(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in [4] out of [4] which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/26/2024
	Plan of Correction
1 2 3 4	Administrator will provide written proof of mold inspection scheduled for the kitchen and bathroom. The Administrator will provide proof in the form of photos of the kitchen cabinet door repair. Administrator will provide proof that the shower head has been replaced. The Administrator will proof additional written proof of the flooring replacement scheduled.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Jazmond D Harris

LICENSING EVALUATOR NAME:

Jacqueline Shaw Ross

LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

LIC809 (FAS) - (06/04)

Page: 3 of 3