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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604477
Report Date: 10/25/2024
Date Signed: 10/25/2024 05:53:03 PM

Document Has Been Signed on 10/25/2024 05:53 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:SCARLETT'S CAREFACILITY NUMBER:
374604477
ADMINISTRATOR/
DIRECTOR:		SORENSON, BRADLEYFACILITY TYPE:
735
ADDRESS:1024 NEPTUNE DRIVETELEPHONE:
(619) 500-5339
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 4CENSUS: 3DATE:
10/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Caregiver Lamance Lynch and Administrator Monica McDadeTIME VISIT/
INSPECTION COMPLETED:
06:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to conduct a Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with DSP Lamance Lynch. LPA then met with Administrator Monica McDade, who arrived later during the visit.

According to the facility’s license, the facility has a maximum capacity of four (4) clients, of whom all must be ambulatory. Per LIC602 Physician’s Reports, staff interviews, and LPA observation: During today’s inspection, there were a total of three (3) clients in care, and all were ambulatory. The facility’s license does not include endorsements for delayed-egress doors or secured perimeter, and neither of these were present.

During today’s visit, LPA performed a welfare check on all clients in care, interviewed multiple facility staff, and reviewed records for all clients and all staff. LPA, accompanied by the Administrator, also toured the interior and exterior of the facility, and inspected all common areas and client bedrooms. 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 and screens, toilets, and showers were working. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities.

The facility’s ambient internal temperature was complaint at 68 F. Hot water temperature at taps accessible to clients were initially non-compliant; Bathroom #1 Sink was 141.4 F and Bathroom #2 Sink was 150.8 F. [During today's visit, adjustments were made to the facility’s water heater to bring the hot water temperature at both sinks back into compliant range.] Appliances to preserve perishable food were compliant in temperature: Kitchen Refrigerator was 37 F, Mini Refrigerator was 40 F, Kitchen Freezer was 0 F, and Garage Freezer was 0 F. There was at least two (2) days of perishable food and at least seven (7) days non-perishable food present, all safely stored. [CONTINUED ON LIC 809-C, 1 of 2]

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 8
Document Has Been Signed on 10/25/2024 05:53 PM - It Cannot Be Edited


Created By: Dang Nguyen On 10/25/2024 at 03:18 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: SCARLETT'S CARE
FACILITY NUMBER: 374604477

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients 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
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Based on measurement with instrument, Licensee did not maintain hot water temperature controls to automatically regulate the temperature of water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F and not more than 120 degrees F. This posed an immediate health and safety risk to 3 of 3 clients (C1 through C3) in care.
POC Due Date: 10/25/2024
Plan of Correction
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During today's visit, adjustments were made to the facility's water heater, such that hot water at taps accessible to clients were brought back to within the complaint temperature range. This resolves the immediate risk. The Plan of Correction is Satisfied.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Lizzette Tellez
LICENSING EVALUATOR NAME:Dang Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2024


LIC809 (FAS) - (06/04)
Page: 2 of 8
Document Has Been Signed on 10/25/2024 05:53 PM - It Cannot Be Edited


Created By: Dang Nguyen On 10/25/2024 at 03:18 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: SCARLETT'S CARE
FACILITY NUMBER: 374604477

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85095.5(b)(2)(C)
Infection Control Requirements
(b) In addition to subsection (a), when one or more clients in the facility are diagnosed with a contagious disease, the following shall apply:  (2) All staff and volunteers providing direct care to a client who has a contagious disease shall wear appropriate Personal Protective Equipment (PPE) to prevent exposure to infectious agents or chemicals through the respiratory system, skin, or mucous membranes of the eyes, nose, or mouth.  PPE may include gloves, gowns, masks, respirators, shoe coverings and eye protection.  (C) The licensee shall ensure all staff and volunteers are trained in the proper use of all required PPE prior to being around clients and annually thereafter. 

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review and interviews, Licensee did not ensure that 10 of 10 facility staff (S1 through S10) were trained in the proper use of all required PPE annually. This posed a potential health risk to persons in care.
POC Due Date: 11/25/2024
Plan of Correction
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Licensee agreed to conduct PPE training for all current staff. The training will include hands-on practice and will cover: a) how perform an N-95 seal check, b) how to correctly don and doff surgical masks, N-95 respirators, face shields, gowns, and gloves, and c) how to set up and manage an isolation bedroom. Licensee agreed to E-mail the training sign-in sheet to LPA, by the POC due date.
Type B
Section Cited
CCR
80066(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 80065(g).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review and manager interview, Licensee did not maintain a health screening within the personnel records of 2 of 10 staff (S1 and S2). This posed a potential health and safety risk to persons in care.
POC Due Date: 11/25/2024
Plan of Correction
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Licensee agreed to complete LIC503 Health Screenings for S1 and S2, signed by a physician, and E-mail these documents to LPA, by the POC due date. Per interview of the administrator, S1 and S2 will be on leave of absence, pending completion of the POC.
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:Lizzette Tellez
LICENSING EVALUATOR NAME:Dang Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2024


LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 10/25/2024 05:53 PM - It Cannot Be Edited


Created By: Dang Nguyen On 10/25/2024 at 03:18 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: SCARLETT'S CARE
FACILITY NUMBER: 374604477

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80066(a)(11)
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: (11) Tuberculosis test documents as specified in Section 80065(g).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review and manager interview, Licensee did not ensure that 1 of 10 staff (S2) had tuberculosis test documents within their personnel records. This posed a potential health risk to persons in care.
POC Due Date: 11/25/2024
Plan of Correction
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Licensee agreed to coordinate with S2 and their doctor to arrange for tuberculosis (TB) testing to be completed on S2. Licensee agreed to E-mail LPA written proof of a negative test result for S2, and to file a copy of such in S2's personnel file, by the POC due date. Per interview of the administrator, S2 will be on leave of absence, pending completion of the POC.
Type B
Section Cited
CCR
80069(c)(1)
Client Medical Assessments
(c) The medical assessment shall include the following: (1) The results of an examination for communicable tuberculosis and other contagious/infectious diseases.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review and manager interview, for 1 of 3 clients (C1), Licensee did not ensure that their medical assessment included the results of an examination for communicable tuberculosis. This posed a potential health risk to persons in care.
POC Due Date: 11/25/2024
Plan of Correction
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Licensee agreed to coordinate with C1's SDRC social worker and/or physician, as needed, to have C1 undergo tuberculosis (TB) testing (such as PPD or chest X-ray). Licensee agreed to E-mail LPA written proof of a negative test result for C1, and to file a copy of such in C1's client record, by the POC due date.
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:Lizzette Tellez
LICENSING EVALUATOR NAME:Dang Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2024


LIC809 (FAS) - (06/04)
Page: 4 of 8
Document Has Been Signed on 10/25/2024 05:53 PM - It Cannot Be Edited


Created By: Dang Nguyen On 10/25/2024 at 03:19 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: SCARLETT'S CARE
FACILITY NUMBER: 374604477

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1565(c)
Other Provisions
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of individuals served by the facility is not required during a drill. While a facility may provide an opportunity for individuals served by the facility to participate in a drill, it shall not require that participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and, if applicable, the names of staff participating in the drill.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review and manager interview: Licensee did not conduct an emergency/disaster drill at least quarterly for each shift. This posed a potential safety risk to 3 of 3 clients [C1, C2, and C3] in care.
POC Due Date: 11/25/2024
Plan of Correction
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Licensee agreed to perform three (3) emergency/disaster drills - one will be on the AM shift (6:00 AM to 2:00 PM), one will be on the PM shift (2:00 PM to 10:00 PM), and one will be on the overnight/NOC shift (10:00 PM to 6:00 AM) - and to document the results in writing. Licensee agreed to E-mail to LPA proof of drill completions, by the POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Lizzette Tellez
LICENSING EVALUATOR NAME:Dang Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2024


LIC809 (FAS) - (06/04)
Page: 5 of 8
Document Has Been Signed on 10/25/2024 05:53 PM - It Cannot Be Edited


Created By: Dang Nguyen On 10/25/2024 at 04:01 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: SCARLETT'S CARE
FACILITY NUMBER: 374604477

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/25/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1565(b)
Other Provisions
(b) If a facility employs staff, the facility shall provide training on the plan to each staff member upon hire and annually thereafter. The training shall include staff responsibilities during an emergency or disaster.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review and interviews, Licensee did not ensure that 10 of 10 staff (S1 through S10) received annual training on the facility's written emergency/disaster plan. This posed a potential safetly risk to persons in care.
POC Due Date: 11/25/2024
Plan of Correction
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Licensee agred to update its existing LIC610D Emergency/Disaster Plan, and then retrain all current staff on it. Licensee agreed to E-mail the training sign-in sheet to LPA, by the POC due date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
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2
3
4
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:Lizzette Tellez
LICENSING EVALUATOR NAME:Dang Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 10/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2024


LIC809 (FAS) - (06/04)
Page: 6 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SCARLETT'S CARE
FACILITY NUMBER: 374604477
VISIT DATE: 10/25/2024
NARRATIVE
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[CONTINUED FROM LIC 809]

There were no sharp objects, toxic chemicals/poisons, active fireplaces, or open-faced heaters accessible to clients. No pools or bodies of water were observed on the premises. Medications were labeled, as required, and stored in locked areas. Confidential records were stored in locked areas. Per the Licensee, no firearms or ammunition are kept at the facility. Fire detection system, carbon monoxide detector, night lights, emergency lighting, and facility telephone were all working. The facility’s fire extinguisher was serviced within the last twelve (12) months. Required licensing postings were observed in visible areas of the facility. Reserve supplies of Personal Protective Equipment (PPE) were on site. Licensee presented proof of current business liability insurance.

During review of client records, LPA observed, and manager interview confirmed: While Client #1 (C1) had a completed medical assessment on file, Licensee did not possess written proof that C1 tested negative for tuberculosis (TB), which was required before C1 moved in. [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] During today’s visit, C1 did not exhibit any sign or symptom of TB observable to the layperson.

During review of staff records, LPA observed, and manager interview confirmed: Licensee did not possess evidence of a completed health screening for either Staff #1 (S1) or Staff #2 (S2), as was required. Whereas S1 had proof of a negative TB test result, Licensee did not possess written proof that S2 tested negative for tuberculosis, which was required before S2 started working. (Per interview of the administrator: S1 and S2 previously worked at the facility but are now on leave of absence, pending completion of these requirements). During today’s visit, all clients and the staff which LPA encountered, did not exhibit any sign or symptom of TB observable to the layperson.

During review of training records, LPA observed: Licensee did not have written proof that 10 of 10 facility staff [Staff #1 (S1) through Staff #10 (S10)] received training on PPE within the last year, as required. Licensee also did not have proof that S1 through S10 received training on the facility’s written Emergency and Disaster Plan within the last year, as required. While Licensee performed some disaster drills over the past year, they fell short of the required frequency of one drill per shift, per quarter.

[CONTINUED ON LIC 809-C, 2 of 2]
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024
LIC809 (FAS) - (06/04)
Page: 7 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SCARLETT'S CARE
FACILITY NUMBER: 374604477
VISIT DATE: 10/25/2024
NARRATIVE
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[CONTINUED FROM LIC 809-C, 1 of 2]

Five (5) deficiencies were cited per California Code of Regulations, Title 22, and two (2) deficiencies were cited per California Health and Safety Code (refer to the LIC 809-D pages). Plans of Correction were jointly developed with the Licensee. LPA also issued two (2) Technical Violations (TVs) regarding tight fitting covers on trash cans and outdoor passageways (refer to the LIC9102-TV pages) and Technical Assistance (TA) regarding staff alert devices on exit doors.

An exit interview was conducted with McDade, to whom a copy of this report, the LIC 809-D pages, the LIC 9102-TV pages, the LIC 9102-TA page, the LIC811 Confidential Names List pages, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during today's visit.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024
LIC809 (FAS) - (06/04)
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