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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372008333
Report Date: 08/02/2024
Date Signed: 08/02/2024 11:45:07 AM

Document Has Been Signed on 08/02/2024 11:45 AM - 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:DOWNSTOWN, INC. VFACILITY NUMBER:
372008333
ADMINISTRATOR/
DIRECTOR:		KECIA STINNETTFACILITY TYPE:
735
ADDRESS:1089 JENNIFER CIRCLETELEPHONE:
(760) 630-0028
CITY:VISTASTATE: CAZIP CODE:
92083
CAPACITY: 4CENSUS: 3DATE:
08/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Kecia Stinnett, Executive Director and Elissa Ciaverelli TIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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On 08/02/24 at 9am Licensing Program Analyst (LPA) Javina George made an unannounced visit for the purpose of conducting a 1 year required visit/annual inspection. LPA George met with informed Executive Director Kecia Stinnett and Administrator Elissa Ciaverelli of the purpose of today's visit. The facility is licensed to serve four (4) developmentally disabled adults, ages 18-59, all of whom must be ambulatory. At the time of LPAs visit there was (3) staff and (0) clients present, as all clients were at work. Below is a summary of what was observed during today’s inspection:

Infection Control: The facility was observed to have an adequate supply of Personal Protective Equipment (PPE) supplies. The facility has an approved mitigation plan on file since 03/22/21.

Physical Plant: LPA toured the interior and exterior of the facility. The home is a single story structure consisting of 4 bedrooms of which 1 is for a live in caregiver and 3 bathrooms, detached garage, backyard with a pool enclosed inside of a locked fence. LPA observed for there to be a (4) drawers inside the kitchen that either had broken or missing handles. The facility is in the process of switching House Managers and are making any necessary repairs, including purchasing a new washer as it is reported to leak when used on the large load setting. All the necessary repairs and purchases will be made by Wednesday 08/07/24 by 5pm, proof will be submitted to department.

Records Review: Staff Records: LPA observed that there are sufficient staff present to meet the needs of residents. LPA George additionally confirmed that there is an Administrator present that does possess a valid certificate. LPA George confirmed staff have criminal record clearance and were associated to the facility and have training to perform their required duties. Staff present at have current CPR/First Aid Certification. The facility will be submitting a request for a change of administrator. All required documentation was received at the time of LPAs visit and the necessary changes will be made.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/02/2024
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: DOWNSTOWN, INC. V
FACILITY NUMBER: 372008333
VISIT DATE: 08/02/2024
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Resident Records: A review of all (3) current clients to confirm that they have the required information present in their files, including Physician's Report, Admissions Agreement. Individual Program Plan (IPP).

Food Services: The kitchen and dining area to be maintained in a clean and healthful manner. LPA George observed the facility to have the required amount of 7 day supply non-perishable and a two supply perishable food items.

Medication:
the medication was observed to be locked in the cabinet above the dishwasher and inaccessible to clients. A review of medication revealed that the medication is being given as prescribed as evidenced by the Medication Authorization Record (MAR) and medication (bubble packs and or pill bottle).

Emergency Disaster Preparedness: The facility has an Emergency Disaster Plan on file and conducts regular disaster drills on a quarterly basis. The last drill was conducted on 04/12/24. The next drill will be conducted within 48 hours and proof of drill will be submitted to LPA by 5pm on 08/05/24. The smoke and carbon monoxide detectors were tested and were found to be operable. The facility has 2 fully charged fire extinguishers. The hot water was tested and was found to be within regulatory limit measuring at 105 degrees Fahrenheit. The facility has emergency food and water supply. The sharps and hazardous chemicals were observed to be locked and inaccessible to residents in care. There are no known guns or ammunition on the premises.

Based on today's inspection there were no deficiencies were cited.

An exit interview was conducted and a copy of this report, were provided to Executive Director Kecia Stinnett, and Administrator Elissa Ciaverelli
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024
LIC809 (FAS) - (06/04)
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