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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600008
Report Date: 04/28/2023
Date Signed: 04/28/2023 02:07:57 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 04/28/2023 02:07 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:DOWNSTOWN VIFACILITY NUMBER:
374600008
ADMINISTRATOR:ELISSA CIAVERELLIFACILITY TYPE:
735
ADDRESS:2248 TIERRA VERDETELEPHONE:
(760) 599-9762
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY: 4CENSUS: 3DATE:
04/28/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
12:49 PM
MET WITH:Executive Director, Kecia StinnettTIME COMPLETED:
02:20 PM
NARRATIVE
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Licensing Program Analyst (LPA), Janira Arreola, made an unannounced visit to the facility in order to conduct the an annual continuation visit that was not completed on 4/27/2023 due to time constraints. LPA was granted entry by and met with the Executive Director, Kecia Stinnett, who was informed of the purpose of the visit.

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.

Record Review and Resident/Staff Files: LPA reviewed (2) staff files and training. All staff have criminal clearance and updated training along with CPR/First Aid Certification. Two (2) client files were reviewed, and possessed all required paperwork.

Health Related Services/ Incidental Medical Services: All client medication was locked in closet. LPA reviewed client medications for (2) client and found all medication listed on MARS 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. LPA observed emergency supplies in the and first aid kit with all required items.

No deficiencies were cited at the time of the visit.

An exit interview was conducted where a copy of this report was provided to the Executive Director, Kecia Stinnett
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2023
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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