374602824-10-17-2023-08-AS-AROS-CWPRGK-20231017130052

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374602824
Report Date: 10/17/2023
Date Signed: 10/17/2023 01:00:59 PM

Document Has Been Signed on 10/17/2023 01:00 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:	CPSRC BMDTP-LAKESIDE		FACILITY NUMBER:	374602824
ADMINISTRATOR:	NANCY ELDRIDGE		FACILITY TYPE:	775
ADDRESS:	11757 TOPO LANE		TELEPHONE:	(619) 561-7405
CITY:	LAKESIDE	STATE: CA	ZIP CODE:	92040
CAPACITY: 30		CENSUS: 23	DATE:	10/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Program Director, Nancy Eldridge		TIME COMPLETED:	01:10 PM

NARRATIVE

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Licensing Program Analysts (LPA) Amy Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Director, Nancy Eldridge.

According to the facility’s license, there may be a maximum of thirty (30) clients at any given time at the day program site, all of which must be ambulatory. During today’s inspection, there were twenty-three (23) clients present at the day program site. The facility does not feature a secured perimeter or delayed egress doors.

LPAs, accompanied by Director Eldridge, toured the interior and exterior of the day program facility. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Doors, windows and screens, sinks, and toilets were in working order. Hand hygiene supplies and Personal Protective Equipment were present. The facility had sufficient space and equipment to facilitate visitation, meetings, and client activities. There is one main building with 2 classrooms, offices, and bathrooms. There is a large, covered area that they use for morning meetings and class activities. The facility’s ambient internal temperature was comfortable and compliant. Hot water temperature in the bathroom taps accessible to clients were also compliant.

Continued on 809-C

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023

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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Document Has Been Signed on 10/17/2023 01:00 PM - It Cannot Be Edited

Created By: Amy Rodgers On 10/17/2023 at 12:29 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: CPSRC BMDTP-LAKESIDE	FACILITY NUMBER: 374602824
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

82066(a)(10)

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator, and each employee. Each personnel record shall contain the following information: (10) A health screening, as specified in Section 82065(g). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based onrecord review, the licensee did not comply with the section cited above in 4 out of 5 staff files reviewed, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/17/2023
	Plan of Correction
1 2 3 4	Director Nancy Eldredge and LPA Rodgers agreed that staff would get a heatlh screening within 30 days and report to CCLD via email

Type B

Section Cited

CCR

82069(a)

Client Medical Assessments

(a) Prior to or within 30 calendar days following the acceptance of a client, the licensee shall obtain a written medical assessment of the client that determines the licensee's ability to provide necessary health-related services to the client. The assessment shall be used in developing the Needs and Services Plan. 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 3 out of 5 which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/17/2023
	Plan of Correction
1 2 3 4	Director Nancy Eldredge and LPA Rodgers agrred to have medical assesments updated in client folders or exclude from program until medical assesments are complete.

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:

Denise Powell

LICENSING EVALUATOR NAME:

Amy Rodgers

LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023

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: CPSRC BMDTP-LAKESIDE	FACILITY NUMBER: 374602824
	VISIT DATE: 10/17/2023

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continued from 809

Licensing Program Analysts (LPA) Amy Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Director, Nancy Eldridge.

According to the facility’s license, there may be a maximum of thirty (30) clients at any given time at the day program site, all of which must be ambulatory. During today’s inspection, there were twenty-three (23) clients present at the day program site. The facility does not feature a secured perimeter or delayed egress doors.

LPAs, accompanied by Director Eldridge, toured the interior and exterior of the day program facility. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Doors, windows and screens, sinks, and toilets were in working order. Hand hygiene supplies and Personal Protective Equipment were present. The facility had sufficient space and equipment to facilitate visitation, meetings, and client activities. There is one main building with 2 classrooms, offices, and bathrooms. There is a large, covered area that they use for morning meetings and class activities. The facility’s ambient internal temperature was comfortable and compliant. Hot water temperature in the bathroom taps accessible to clients were also compliant.

Continued on 809-C

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023

LIC809 (FAS) - (06/04)

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