374600155-3-22-2023-08-AS-DNGN-CQ6VBR-20230322161757

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374600155
Report Date: 03/22/2023
Date Signed: 03/22/2023 04:18:01 PM

Document Has Been Signed on 03/22/2023 04:18 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	VIA CALLADO ARF #2		FACILITY NUMBER:	374600155
ADMINISTRATOR:	TYRONE POWELL		FACILITY TYPE:	735
ADDRESS:	5113 FRANCIS STREET		TELEPHONE:	(760) 722-8850
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92057
CAPACITY: 6		CENSUS: 6	DATE:	03/22/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:48 AM
MET WITH:	Administrator Tyrone "Aaron" Powell and Assistant Administrator Maria DeGuzman		TIME COMPLETED:	04:30 PM

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Licensing Program Analysts (LPAs) Dang Nguyen and Alyssa Ramirez conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit with Administrator Tyrone “Aaron” Powell and Assistant Administrator Maria DeGuzman.

According to the facility’s license, the facility has a maximum capacity of six (6) clients, of which two (2) may be non-ambulatory; the non-ambulatory clients must be assigned to the bedroom with a “direct exit” sliding door. During today’s inspection, there were a total of six (6) clients in care, of which one (1) was non-ambulatory. This non-ambulatory client was also assigned to the correct/approved bedroom for their status. This facility does not feature a secured perimeter or delayed egress doors.

LPAs, accompanied by licensee’s staff, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was 70 F. Refrigerator temperature was 40 F and freezer temperature was 0 F.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas. Confidential records were stored in locked areas.

[CONTINUED ON LIC 812-C]

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: VIA CALLADO ARF #2	FACILITY NUMBER: 374600155
	VISIT DATE: 03/22/2023

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[CONTINUED FROM LIC 809]

No pools or bodies of water were observed on the premises. Per the licensee, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPAs interviewed multiple staff and clients and reviewed multiple staff and client records/files. LPA’s interviews did not raise any licensing concerns. The files which LPAs reviewed contained required documents. Licensee also presented proof of current/active business liability insurance and surety bond. LPAs left the facility to take a lunch break from around 12:00 PM to 1:00 PM.

During today’s visit, LPAs observed via measurement with a thermometer device, that hot water temperature at taps accessible to clients were initially non-compliant. Water from the kitchen sink reached 140 F. Water in the hallway bathroom, which was frequented by all clients in care, reached 136 F. (Per regulation, hot water temperature at taps accessible to clients is required to be between 105 F and 120 F.) Interviews of staff and clients did not reveal evidence of any client suffering an actual adverse health consequence as a result of hot water at the facility.

A deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D). A Plan of Correction was jointly developed with the licensee. An exit interview was conducted with DeGuzman, to whom a copy of this report, the LIC 809-D, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/22/2023 04:18 PM - It Cannot Be Edited

Created By: Dang Nguyen On 03/22/2023 at 03:37 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 ARF #2	FACILITY NUMBER: 374600155
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/22/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80088(e)(1)

Fixtures, Furniture, Equipment, and Supplies

(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and measurement, the licensee did not comply with the section cited above for 6 of 6 clients [Clients #1 through #6], which posed a potential safety risk to persons in care.
	POC Due Date: 03/22/2023
	Plan of Correction
1 2 3 4	During today's visit, staff made adjustments to the facility's water heater and LPA re-measured the hot water temperatures prior to departure. After adjustemnt, the kitchen tap reached 117 F, the hallway bathroom reached 115.2 F, and the master bathroom reached 111 F. All taps were thus made compliant, allowing CCLD to clear the deficiency during the visit.

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:

Lizzette Tellez

LICENSING EVALUATOR NAME:

Dang Nguyen

LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023

LIC809 (FAS) - (06/04)

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