374604132-1-24-2024-08-AS-CLOZ-CZSUFX-20240124143327

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604132
Report Date: 01/24/2024
Date Signed: 01/24/2024 02:34:14 PM

Document Has Been Signed on 01/24/2024 02:34 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:	RUSSELL HOMES INC SANTEE		FACILITY NUMBER:	374604132
ADMINISTRATOR:	MCKNIGHT COLE, TRACY		FACILITY TYPE:	735
ADDRESS:	10214 THREE OAKS WAY		TELEPHONE:	(619) 938-2667
CITY:	SANTEE	STATE: CA	ZIP CODE:	92071
CAPACITY: 4		CENSUS: 4	DATE:	01/24/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:03 AM
MET WITH:	Krista Duvall, Administrator		TIME COMPLETED:	02:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required Annual Inspection. The facility file was reviewed prior to the visit. LPA Lopez identified herself, was granted entry by Administrator Krista Duvall. LPA discussed the purpose of today’s visit with Administrator Duvall. According to the facility’s license, there may be a maximum of four (4) clients all of whom may be ambulatory in at any given time at the facility site. During today’s inspection, the facility’s current census is 4 clients living at the facility. There were no client present at the facility site during the inspection, until later that afternoon. LPA, accompanied by Administrator Duvall, 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, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and activities. The facility’s ambient internal temperature was comfortable and compliant, at 71 degrees Fahrenheit (F). Hot water temperature at taps accessible to clients measured as follows: kitchen sink measured at 119.3 degrees F; sink in restroom #1 delivered hot water at 108 degrees F; sink in restroom #2 delivered hot water at 121.2 degrees F. There was at least 2 days of perishable food, and at least 7 days non-perishable food present. Cooking/dining equipment and utensils were present, and all safely stored. There were no toxic chemicals/poisons accessible to clients. Medications were properly labeled, as required, and stored in a closet. The facility maintained medication logs which LPA reviewed. [CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2024

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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: RUSSELL HOMES INC SANTEE	FACILITY NUMBER: 374604132
	VISIT DATE: 01/24/2024

NARRATIVE

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[CONTINUED FROM LIC 809]

No pools or bodies of water on the premises. Per Administrator Duvall, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present (01) and serviced. First aid kit(s) were complete and readily accessible.

LPA was able to interview 1 staff and 2 clients, and reviewed staff and client records. During today’s visit clients and staff interviewed did not raise licensing concerns. LPA facility tour and review of client records did not raise licensing concerns at the time of the visit. The files which LPA reviewed contained required documents. Confidential records were stored in a locked closet. Required licensing postings were observed in a visible area of the facility.

There were no deficiencies observed or cited during today's annual inspection.

An exit interview was conducted with Administrator Krista Duvall to whom a copy of this report along with the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit. The signature below confirms the documents were received.

LPA requested Administrator Duvall to submit a current Designation of Administrative Responsibility LIC 308 to the licensing office within 10 days. Administrator Duvall submitted a copy of the facility's Personnel Report LIC 500, Emergency Disaster Plan LIC 610-D, and Residential Infection Control Plan LIC 9282 (6/23) during the annual inspection. Forms are available at www.ccld.ca.gov.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2024

LIC809 (FAS) - (06/04)

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