374604330-10-12-2023-08-AS-AROS-CWJLLL-20231012085116

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604330
Report Date: 10/04/2023
Date Signed: 10/12/2023 08:51:45 AM

Document Has Been Signed on 10/12/2023 08:51 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	AMARIS CENTER FOR CHANGE		FACILITY NUMBER:	374604330
ADMINISTRATOR:	GASQUE, RUKHSANA		FACILITY TYPE:	775
ADDRESS:	250 E DOUGLAS AVE		TELEPHONE:	(202) 520-3781
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92020
CAPACITY: 40		CENSUS: 30	DATE:	10/04/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Joseph Baker, House Manger		TIME COMPLETED:	03:10 PM

NARRATIVE

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Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by Joseph Baker, House Manger with whom LPA discussed the purpose of the visit. Administrator Shanta Haines arrived at the facility during the inspection as well as Licensee Rukhsana Gasque.

According to the facility’s license, there may be a maximum of forty (40) developmentally disabled adults ages 18 and above;, all of which are ambulatory. During today’s inspection, there were thirty (30) clients present at the day program site. The facility does not feature a secured perimeter or delayed egress doors.

LPA, accompanied by house manager Joeseph Baker, 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 sinks, and toilets were in working order. Hand hygiene supplies and Personal Protective Equipment were present. Facility does not prepare food on the premises and clients bring their own lunches. Snacks are available as needed. The facility had sufficient space and equipment to facilitate meetings and client activities. The facility’s ambient internal temperature was comfortable and compliant with Regulations.

All sharp objects or toxic chemicals/poisons were in a locked area. There are four (4) working bathrooms.. Signal System was present both upstairs and downstairs. Emergency lighting and facility telephone were all working. Fire extinguishers (2) were in working order. First aid kit was complete and readily accessible. Facility able to provide arrangements or transportation all off site work.

[CONTINUED ON LIC809-C]

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

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 10/12/2023 08:51 AM - It Cannot Be Edited

Created By: Amy Rodgers On 10/04/2023 at 02:17 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: AMARIS CENTER FOR CHANGE	FACILITY NUMBER: 374604330
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/04/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

82088(e)(1)

Fixtures, Furniture, Equipment, and Supplies

(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures 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 the licensee did not comply with the section cited above in 4 of 4 client bathrooms which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 10/06/2023
	Plan of Correction
1 2 3 4	LIcensee agreed to have water tempratured adjust as soon as she can get a maintaince person on site. Maintaince will arrive by 4pm today 10/4/2023 to adjust water heater. Day program ended approximated 1:30pm. All Clients went home for the day. No immediate danger to clients. The administrator will send photos of water temp with time and date.

Type B

Section Cited

CCR

82023(d)

Disaster and Mass Casualty Plan

(d) Disaster drills shall be conducted at least every six months. 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 in1 of 1 which poses/posed a potential health, safety or personal rights risk to persons in care. Last disaster drill was 8/2/2022.
	POC Due Date: 10/09/2023
	Plan of Correction
1 2 3 4	Administartor agreed that a disaster drill will take place no later than 10/6/2023. Will send evidence to CCLD when 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: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

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: AMARIS CENTER FOR CHANGE	FACILITY NUMBER: 374604330
	VISIT DATE: 10/04/2023

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[CONTINUED FROM LIC809]

LPA interviewed multiple staff and clients. LPA interviews did not raise any licensing concerns. LPA also reviewed multiple staff and client records/files. Files reviewed contained required documents. Confidential records were stored in locked areas. Required licensing postings were observed in visible areas of the facility.

Based on today's inspection there are two deficiencies observed at this time in the areas evaluated. The water temperature in the bathrooms were not complaint and The fire drill/disaster drill was not complaint.

An exit interview was conducted, this report was discussed with Administrator Shanta Haines and a copy along with Licensee/Appeal Rights (LIC 9058 01/2106), and their signature on this form acknowledges receipt and a copy of the report was given to the Administrator Shanta Haines..

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2023

LIC809 (FAS) - (06/04)

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