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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603533
Report Date: 03/18/2024
Date Signed: 03/18/2024 04:22:18 PM

Document Has Been Signed on 03/18/2024 04:22 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:WORK SKILL RESOURCESFACILITY NUMBER:
374603533
ADMINISTRATOR:ENUNWA, EBELEFACILITY TYPE:
775
ADDRESS:9349 JAMACHA BLVDTELEPHONE:
(619) 512-1107
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY: 60CENSUS: 48DATE:
03/18/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Tracy Mcknight- AdministratorTIME COMPLETED:
02:38 PM
NARRATIVE
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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced Case Management visit to. LPA met with Tracy Mcknight- Administrator and explained the reason for this visit.

During today's visit, the Department conducted an investigation after Licensee self-reported an incident which had occurred on 03/13/2024, in which Client #1 (C1) went to a liquor store and purchased alcohol and drank it while on a work site with staff. C1 ended up being intoxicated and was throwing up. Interviews revealed C1 admitted going next door to the liquor store and purchasing between 4-6 small shots of vodka. C1 went back to the work site and started apologizing to the staff, staff asked what they were apologizing for and C1 would not answer. The staff and 4 clients then left the work site and C1 started to throw up in the van. They got back to the facility and C1 laid down and was offered water. C1 laid down at the facility and explained to the administrator that they went to the liquor store behind the work site and purchased alcohol. One of the staff took C1 home after the administrator spoke with the administrator of C1s facility. CCLD initially had concerns regarding staff supervision.

The Department's investigation involved multiple interviews along with review of facility and medical records/ Individual Program Plan. The evidence showed: C1 is ambulatory, independent with all activities of daily living, and able to communicate their needs. C1's physician report states that C1 cannot leave the facility unassisted. Staff had observed C1 prior to the incident, and there were no indications that C1 was in distress or required assistance. Once the client came in from locking the dumpsters and apologizing to staff is when the staff knew something was not right.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2024
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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Document Has Been Signed on 03/18/2024 04:22 PM - It Cannot Be Edited


Created By: Tiffany Holmes On 03/18/2024 at 01:36 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: WORK SKILL RESOURCES
FACILITY NUMBER: 374603533

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/29/2024
Section Cited
CCR
82078(a)

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Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision necessary to meet the client's needs and all services specified in the admission agreement.This requirement is not met as evidenced by:
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Administrator stated they provided training to the staff on 03/13/2024 on Supervison Practices. Administrator will provide training on 03/20/24 by an outside source to all staff on Supervision while out in the community and Community Safety. Administrator will provide sign in sheet and training materials to CCL. The POC will be due to CCL by 03/29/2024.
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Based on interviews and record review, the licensee did not ensure supervision was provided to 1 out of 4 [C1] clients, which posed a potential health and safety risk to clients in care.
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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:Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2024


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: WORK SKILL RESOURCES
FACILITY NUMBER: 374603533
VISIT DATE: 03/18/2024
NARRATIVE
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Based on the preponderance of evidence obtained, the Department did determine that there was a lack of staff supervision in regard to this incident. Deficiencies were issued during today's case management visit.

An exit interview was conducted with Tracy Mcknight Administrator, to whom a copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit. Mcknight's signature confirms receipt of these documents.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024
LIC809 (FAS) - (06/04)
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