374600947-5-6-2024-18-AS-JSRS-D4WUDQ-20240503152954

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374600947
Report Date: 05/03/2024
Date Signed: 05/06/2024 08:10:38 AM

Document Has Been Signed on 05/06/2024 08:10 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:	JIMLYS ARF		FACILITY NUMBER:	374600947
ADMINISTRATOR/ DIRECTOR:	SHERYL ANN BARAWID		FACILITY TYPE:	735
ADDRESS:	1010 METCALF STREET		TELEPHONE:	(760) 781-1197
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92026
CAPACITY: 6		CENSUS: 1	DATE:	05/03/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:50 PM
MET WITH:	Sheryl Barawid, Administrator		TIME VISIT/ INSPECTION COMPLETED:	03:35 PM

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Licensing Program Analyst (LPA) Jacqueline Shaw Ross conducted an unannounced annual required visit on 5/3/2024. LPA was granted entry and met with Administrator, Sheryl Barawid, who was informed of the purpose of the visit. At the time of the visit there was one staff and one client present. LPA was informed clients were out in the community.

The facility is a one story home with (4) bedrooms and (2) bathrooms. No pools or firearms are being kept at the facility. The clients served are adults between the ages of 18-59. LPA conducted a tour of the interior and exterior, reviewed facility documents. LPA observed the following:

Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies. 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.

Physical Plant: LPA observed the client bedrooms. Physical plant was observed to be clean and damage free. The floors were clean and furniture was in good condition. The outdoor area was observed to be free of hazards. Laundry equipment was observed to be operational. The sharp and dangerous objects were observed to be locked and inaccessible to clients in medication cabinet. The smoke detector and carbon monoxide was operational, and the hot water temperature 111 degrees F. LPA observed all facility exits were clear from obstructions.

Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024

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: JIMLYS ARF	FACILITY NUMBER: 374600947
	VISIT DATE: 05/03/2024

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Care & Supervision/Administration: LPA also reviewed the staff scheduled showing adequate staff coverage. Facility sketch, exit routes, personal rights, complaint information and emergency phone numbers were found posted in the facility. Administrator's certification is still pending. LPA was provided a copy of cleared check and certificate number showing fees paid as proof of filing.

Record Review and Resident/Staff Files: LPA reviewed 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. Client's P&I funds are kept separately from facility funds and were accounted for.

Health Related Services/ Incidental Medical Services: All client medication was locked in a cabinet. LPA reviewed client medications, medication is properly stored and dispensed according to physicians orders.

Disaster preparedness: LPA reviewed the facility's emergency and disaster plan was last updated on April 16, 2024. LPA reviewed documentation showing the facility's last fire drill conducted in November 7, 2023, which met the department requirements. LPA observed emergency supplies and first aid kit.

No deficiencies were observed in today's inspection. An exit interview was conducted where a copy of this report was provided to Administrator, Sheryl Barawid.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE:	DATE: 05/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024

LIC809 (FAS) - (06/04)

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