372008307-3-6-2023-18-AS-JARA-CPNUCH-20230306142759

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 372008307
Report Date: 03/06/2023
Date Signed: 03/06/2023 02:28:24 PM

Document Has Been Signed on 03/06/2023 02:28 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	LEARNING SERVICES ESCONDIDO-ADULT DAY CARE		FACILITY NUMBER:	372008307
ADMINISTRATOR:	IRWIN ALTMAN		FACILITY TYPE:	775
ADDRESS:	2335 BEAR VALLEY PKWY.		TELEPHONE:	(760) 746-3223
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92027
CAPACITY: 28		CENSUS: 15	DATE:	03/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:24 AM
MET WITH:	Clinical Director, Sue Phillips		TIME COMPLETED:	02:35 PM

NARRATIVE

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Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit on 3/6/2023 at 10:24 a.m. LPA was granted entry and met with staff Sue Phillips and Uriel Neis who was informed of the purpose of the visit. LPA spoke with current administrator Kathrin Baer over the phone. At the time of the visit there were (5) clients present.

The facility is a one story facility with (3) activity room and (3) bathrooms for clients between the ages of 18-59. LPA conducted a tour of the interior and exterior of the facility and observed the following:

Infection Control: The LPA observed the hand washing stations in the facility had a hand washing sign with proper steps on hand washing. LPA also observed gloves in client restrooms, and cleaning supplies to do regular cleaning of the facility. The facility is currently screening and taking temperature for facility visitors.

Physical Plant: LPA observed activity materials in activity rooms. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. There is an adequate number of activity rooms for the capacity of the facility. The outdoor area was observed to have a shaded area for clienst and was free of hazards. Chemicals were observed in a locked maintenance closet.

Operating Requirements: The facility has secured a fire clearance that is for 28 non-ambulatory clients combined with the residential program next door.

Food Service: LPA observed kitchen used for therapy had the ability to prepare food in clean environment and possessed equipment in good working condition. The LPA noted a drawer that with lock that was not operation in the facility kitchen where client one-on-one activities are conducted. This drawer had sharp objects in it such as kitchen knifes. No clients were in or around the area at the time. The LPA will document Technical advisory note for this.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

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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Document Has Been Signed on 03/06/2023 02:28 PM - It Cannot Be Edited

Created By: Janira Arreola On 03/06/2023 at 01:42 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: LEARNING SERVICES ESCONDIDO-ADULT DAY CARE	FACILITY NUMBER: 372008307
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

82019(e)(3)

Criminal Record Clearance

(e) Prior to working, residing or volunteering in a licensed day program, all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall do the following: (3) Request the licensee or applicant for a license to request a transfer of a criminal record clearance as specified in Section 82019(f); or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above in (1) employee (S1) that was not associated to the facility roster. This poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/07/2023
	Plan of Correction
1 2 3 4	The administrator agreed to transfer S1 to the facility roster through Guardian. The administrator shall send proof of this being completed by the POC due date.

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:

Joel Esquivel

LICENSING EVALUATOR NAME:

Janira Arreola

LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: LEARNING SERVICES ESCONDIDO-ADULT DAY CARE	FACILITY NUMBER: 372008307
	VISIT DATE: 03/06/2023

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Care & Supervision/Administration: Adequate staff are present for the supervision of residents. Emergency exiting plans, telephone numbers and personal rights were found posted in the facility. The listed administrator is not the current administrator. The administrator Kathrin Baer stated that notification was sent to the San Diego office before the facility was switched to the Riverside Regional Office. LPA will document technical violation for this and communicated to administrator over the phone that new documents would need to be submitted to the riverside regional office.

Record Review and Resident/Staff Files: LPA noted on the facility LIC500 that one (1) staff, Staff #1 S1, was not associated to the facility roster. The facility will receive a type A deficiency for this with attached civil penalty of $500. Plan of Correction was documented for this. All other staff have criminal clearance and updated training along with CPR/First Aid Certification. Staff files reviewed were found to be complete. The resident files were also found to be complete as well.

Health Related Services/ Incidental Medical Services: All resident medication was locked in a medication room. The narcotics are kept double locked in a locked utility storage cabinet. The facility current has resident with diabetes that do not require injections.

Disaster preparedness: LAP reviewed the facility emergency and disaster plan. LPA reviewed documentation showing the facility fire alarms had been inspected 12/20/2022. The facility emergency file was found to meet all requirements. LPA observed all facility exits were clear from obstructions.

An exit interview was conducted where a copy of this report along with LIC 809-D pages and appeal right were provided to Clinical Director, Sue Phillips.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023

LIC809 (FAS) - (06/04)

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