372008416-10-1-2024-08-AS-RARZ-D9MT6K-20241001142717

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 372008416
Report Date: 10/01/2024
Date Signed: 10/01/2024 02:27:24 PM

Document Has Been Signed on 10/01/2024 02:27 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:	VIA CALLADO		FACILITY NUMBER:	372008416
ADMINISTRATOR/ DIRECTOR:	TYRONE POWELL		FACILITY TYPE:	735
ADDRESS:	772 VIA CALLADO		TELEPHONE:	(760) 730-5082
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92057
CAPACITY: 6		CENSUS: 5	DATE:	10/01/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:45 AM
MET WITH:	Administrator Tyrone Aaron Powell		TIME VISIT/ INSPECTION COMPLETED:	02:35 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) Rebecca Ruiz conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Administrator Tyrone "Aaron" Powell. The facility is licensed for a maximum capacity of 6 ambulatory clients. During today’s visit, the facility had a census of 5 ambulatory clients. The Administrator for the facility is Tyrone Powell and their certificate was valid and current. During today’s visit, LPA toured the facility and inspected each room of the facility, including client rooms, bathrooms for client and staff use, kitchen, garage, common areas, and outside space. No bodies of water were observed on the premises. LPA did not observe any aspects of delayed egress or secured perimeter. LPA observed dry wall and wooden boards, vehicle tires, and other construction supplies and clutter stored in the facility backyard and are accessible to clients. Per Administrator, the clients do not access the backyard, however, a client room exits directly into the backyard. The facility’s water temperature was measured at 119.8 degrees Fahrenheit in a common bathroom. The facility’s internal temperature was measured at 74 degrees Fahrenheit. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. According to Tyrone "Aaron" Powell, no firearms or weapons are stored on the premises. LPA also observed locked storage for client medications and client and staff files. Client medications are stored in their original container and labelled. Review of clients' Medication Administration Record (MAR) log revealed that the MAR log for 3 of 5 clients are not kept up to date with currently prescribed medications. Additionally, medications that have been discontinued are still being signed as given to clients. Review of client medications and interviews with staff did not reveal any evidence that medications that do not have a current doctor's order or that have been discontinued have been given to clients. Continued on LIC809-C page…

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024

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: VIA CALLADO	FACILITY NUMBER: 372008416
	VISIT DATE: 10/01/2024

NARRATIVE

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LPA observed a minimum of a 2-day supply of perishable food and a 7-day supply of non-perishable food present at the facility. The facility refrigerator was kept at 45 degrees Fahrenheit, and the facility freezer was kept at 0 degrees Fahrenheit. LPA observed linens and hygiene products provided to the clients that are in good repair and sufficient to meet their needs. Staff present at the facility during the time of the inspection had a criminal background clearance, were associated to the facility, and had a first aid certificate.

LPA reviewed multiple client and staff records. Each client record contained a signed admission agreement, updated physician’s report and medical assessment, documents regarding safeguarding personal property and cash resources, and personal rights. LPA reviewed clients’ personal and incidental money and ledger with the Administrator did not discover any inconsistencies. Each staff file was complete and contained a personnel record, first aid certificate, fingerprint clearance and association, and a health screening. LPA spoke with staff and clients present at the facility during the time of the inspection and those interviews did not reveal any licensing or regulatory concerns.

The Administrator will submit copies of the LIC500 Personnel Report and LIC610D Disaster Plan to the Department within 15 business days.

The following deficiencies for medication records and building and grounds were cited and noted on the attached LIC809-D page.

An exit interview was conducted with Co-Administrator Maria DeGuzman and Administrator Tyrone "Aaron" Powell, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 10/01/2024 02:27 PM - It Cannot Be Edited

Created By: Rebecca A Ruiz On 10/01/2024 at 01:39 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: VIA CALLADO	FACILITY NUMBER: 372008416
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/01/2024

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, the licensee did not comply with the section cited above in that construction supplies and other clutter were accessible to clients in the backyard. This poses a potential safety risk to 5 of 5 clients in care.
	POC Due Date: 10/25/2024
	Plan of Correction
1 2 3 4	Administrator will relocate clutter to existing cabinets outside and will install doors with a latch and lock to secure items. Administrator will call junk haulers to have any items that need to be thrown away hauled off of the facility property. Adminstrator will notify LPA in writing when the backyard has been cleared by POC due date of 10/25/2024.

Type B

Section Cited

CCR

80070(a)

(a) The licensee shall ensure that a separate, complete, and current record is maintained in the facility for each client. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that 3 of 5 clients Medication Administration Records (MARs) were not kept updated with current medications or staff signatures for medication administration which poses a potential health risk to 5 of 5 clients in care.
	POC Due Date: 10/25/2024
	Plan of Correction
1 2 3 4	Co-Administrator will audit clients' medications and doctors orders and will contact clients' pharmacy to request updated MARS records for any clients that need to be updated. Co-Administrator stated staff will receive online medication training. Co-Administrator will submit copies of medication training certificate to the Department by POC due date of 10/25/2024.

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:

Rebecca A Ruiz

LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2024

LIC809 (FAS) - (06/04)

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