372008105-5-22-2024-18-AS-JSRS-D5HUS5-20240522154946

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 372008105
Report Date: 05/22/2024
Date Signed: 05/22/2024 03:49:52 PM

Document Has Been Signed on 05/22/2024 03:49 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	LEARNING SERVICES ESCONDIDO-ADULT RESIDENTIAL		FACILITY NUMBER:	372008105
ADMINISTRATOR/ DIRECTOR:	BAER, KATHRIN		FACILITY TYPE:	735
ADDRESS:	2335 BEAR VALLEY PARKWAY		TELEPHONE:	(760) 746-3223
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92027
CAPACITY: 28		CENSUS: 18	DATE:	05/22/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:45 PM
MET WITH:	Kathrin Baer, Administrator/RN		TIME VISIT/ INSPECTION COMPLETED:	03:55 PM

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Licensing Program Analyst (LPA) Jacqueline Shaw Ross conducted an unannounced annual required visit on 5/22/2024 at 12:45 p.m. LPA was granted entry and met with Administrator, Kathrin Baer and Operations Manager Uriel Neis who was informed of the purpose of the visit. At the time of the visit there was (10) staff and (2) clients present. LPA was informed the rest of the clients were on an outing in the community.

The facility is a one story building with (13) bedrooms and (6) bathrooms. The facility is comprised of (2) buildings which sit on the same lot as the day program (372008307). No pools or firearms are being kept at the facility. The clients served are adults between the ages of 18-59 who have been diagnosed with a neurological handicap. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted staff and client interviews. LPA observed the following:

Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements. LPA reviewed staff records and found that all staff had infection control training.

Physical Plant: LPA observed the client bedrooms. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. LPA observed outdoor furniture and shaded area for clients. Laundry equipment was observed to be in good working condition. LPA observed the cleaning supplies were kept in an locked cabinet under the kitchen sink as well as in a locked cabinet in the laundry room. The smoke detector and carbon monoxide were operational, and the hot water temperature 120 F.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024

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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: LEARNING SERVICES ESCONDIDO-ADULT RESIDENTIAL	FACILITY NUMBER: 372008105
	VISIT DATE: 05/22/2024

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Food Service: LPA observed facility kitchen had the ability to prepare food in a clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods.

Care & Supervision/Administration: Adequate staff are present for the supervision of clients during the visit. Facility sketch, exit routes, personal rights, and emergency phone numbers were found posted in the facility. LPA confirmed the listed administrator certification expires on February 22, 2025.

Record Review and Resident/Staff Files: LPA reviewed (3) staff files and training. All staff have criminal clearance and updated training along with CPR/First Aid Certification. Three (3) client files were reviewed, and possessed all required paperwork.

Health Related Services/ Incidental Medical Services: All client medication was locked in the med room. LPA reviewed random client medications and found all medication listed on QMARS and all required labeling was found to be in place.

Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing the facility's last fire and earthquake drills, which met the department requirements. LPA observed all facility exits were clear from obstructions. Emergency supplies and the first aid kits are located throughout the campus and contained all required items.

No deficiencies were observed during today's inspection.

An exit interview was conducted where a copy of this report was provided to the Administrator, Kathrin Baer.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024

LIC809 (FAS) - (06/04)

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