401701252-8-3-2023-29-AS-DCHZ-CUCTXN-20230803150726

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 401701252
Report Date: 08/03/2023
Date Signed: 08/03/2023 03:08:16 PM

Document Has Been Signed on 08/03/2023 03:08 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	ESCUELA DEL RIO		FACILITY NUMBER:	401701252
ADMINISTRATOR:	DEBORAH ARGANO		FACILITY TYPE:	775
ADDRESS:	5940 ROSARIO AVE		TELEPHONE:	(805) 466-4438
CITY:	ATASCADERO	STATE: CA	ZIP CODE:	93422
CAPACITY: 80		CENSUS: 40	DATE:	08/03/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:07 AM
MET WITH:	Eric Saloum, Program Director, and Debbie Argano, Executive Director/Administrator		TIME COMPLETED:	03:25 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	On 8/3/23 at 10:02 am, Licensing Program Analyst (LPA) Chavez conducted an unannounced Annual/Required visit to the facility listed above. LPA met with Eric Saloum, Program Director, and explained the purpose of the visit. Miguel Magana, Quality Assurance Specialist (QAS) from Tri-Counties Regional Center was also in attendance. At approximately 11:30 am, Debbie Argano, Executive Director/Administrator, joined the visit. LPA toured facility with the PD and QAS. The program is community based. The program site is clean, safe, sanitary and in good repair for the safety and well-being of clients, employees, and visitors. Facility is maintained in conformity with state fire marshal regulations. Smoke detectors are in classrooms and the kitchen. The large activity room does not have a smoke detector, however, it has a fire pull. The carbon monoxide detector located in the lobby area was tested and functioning properly. Hot water temperatures in client bathrooms and kitchen measured between 108.1 F and 109.1 F degrees. All toilets and hand washing facilities are maintained in a safe, sanitary, operating condition. Each client is accorded safe, healthful, and comfortable accommodations, furnishings and equipment to meet his/her needs. Snacks are provided and clients bring their own lunches. Food is stored and prepared in a safe and healthful manner. Disinfectants, cleaning solutions and poisons are inaccessible to clients. Facility has adequate emergency and first aid supplies. Fire extinguishers (5) are located in the large activity room, lobby, end of hall near classrooms, vocational room, and shed. Extinguishers were fully charged and last inspected on 2/10/23 and 2/17/23. Facility temperature is 74 F degrees. Outdoor walkways are free from obstruction and the facility has outside fenced areas for individuals to use. PD says that currently they do not dispense medications to any clients and if they did, the PD has a locked box in his office for these items. LPA observed sufficient staff to client ratio. Continued on 809-C.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

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 08/03/2023 03:08 PM - It Cannot Be Edited

Created By: Darlene Chavez On 08/03/2023 at 02:37 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
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ESCUELA DEL RIO	FACILITY NUMBER: 401701252
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

82010

Limitations on Capacity

A licensee shall not operate a day program beyond the conditions and limitations specified on the license, including the capacity limitation. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review and interviews, the licensee did not comply with the section cited above in one (1) out of five (5) client records reviewed indicate Client #1's physician report shows a non-ambulatory status which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/11/2023
	Plan of Correction
1 2 3 4	Licensee will immediately ensure C1 does not return to day program and either obtain an ambulatory status or if unable to, ensure C1 does not return to day program.

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 and interviews, the licensee did not comply with the section cited above in that the facility had one emergency disaster drill in the past year which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/11/2023
	Plan of Correction
1 2 3 4	Licensee will write a Statement of Understanding showing that the licensee has read, understands, and will comply with the regulation cited above.

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:

Kelly Burley

LICENSING EVALUATOR NAME:

Darlene Chavez

LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ESCUELA DEL RIO	FACILITY NUMBER: 401701252
	VISIT DATE: 08/03/2023

NARRATIVE

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The most recent emergency disaster drill was conducted on 6/29/23. PD says there was a drill conducted in October 2022 but does not have documentation on this. Deficiency cited.

LPA conducted a file review of five (5) clients. Client files reviewed had tuberculosis results, admission agreements and current needs and services plans. All files were updated with the exception of Client #1 (C1) who does not have a signed admission agreement. Technical Violation issued. Additionally, the physician report for C1 says that their fire clearance status is “Non-ambulatory” which violates the facility’s fire clearance. Deficiency cited and civil penalty issued. Four (4) out of five (5) client records reviewed did not include contact information for clients' dentists. Technical Violation issued. Licensee will update client records and send to LPA by 8/10/23.

LPA conducted a file review of five (5) staff for criminal record clearances and associations, Health screening with TB results, current First Aid/CPR, and adequate training hours. All records are in-compliance.

Exit interview conducted, deficiencies cited, technical violations issued, civil penalty issued, and the report and appeal rights given.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

LIC809 (FAS) - (06/04)

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