401703246-8-2-2023-29-AS-DCHZ-CUBV5V-20230802160835

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 401703246
Report Date: 08/02/2023
Date Signed: 08/02/2023 04:09:57 PM

Document Has Been Signed on 08/02/2023 04:09 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 - TOWARD INDEPENDENCE PROGRAM		FACILITY NUMBER:	401703246
ADMINISTRATOR:	DEBORAH ARGANO		FACILITY TYPE:	775
ADDRESS:	1205 EL CAMINO REAL		TELEPHONE:	(805) 466-7032
CITY:	ATASCADERO	STATE: CA	ZIP CODE:	93422
CAPACITY: 30		CENSUS: 30	DATE:	08/02/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:17 AM
MET WITH:	Julia Renzaglia, Program Director, and Debbie Argano, Administrator		TIME COMPLETED:	04:30 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 8/2/23 at 10:17 am, Licensing Program Analyst (LPA) Chavez conducted an unannounced Annual/Required visit to the facility listed above. LPA met with Julia Renzaglia, Program Director (PD), and explained the purpose of the visit. At 1:00 pm, Debbie Argano, Administrator, arrived and joined the meeting. LPA toured facility with the PD. 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. The smoke detectors are hardwired and part of the sprinkler system. The carbon monoxide detector was tested and functioning properly. Hot water temperatures in client bathrooms and kitchen measured between 118.7 F and 119 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 individuals. Facility has adequate emergency and first aid supplies. Fire extinguishers (2) are located in the large activity room near the electrical room and next to the kitchen entrance. Extinguishers were fully charged and last inspected on 2/17/23. Facility temperature is about 70 degrees. Outdoor walkways are free from obstruction and the facility has fenced areas outside for individuals to use. Centrally stored medications are locked in a file cabinet in the PD’s locked office and inaccessible to clients. The Centrally Stored Medications are recorded and filed in the locked cabinet. LPA observed sufficient staff to client ratio. The last emergency disaster drill was conducted on 8/1/23. Administrator confirms there were no other drills conducted in the last six months. Deficiency cited. Continued on 809-C.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

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 08/02/2023 04:09 PM - It Cannot Be Edited

Created By: Darlene Chavez On 08/02/2023 at 03:30 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 - TOWARD INDEPENDENCE PROGRAM	FACILITY NUMBER: 401703246
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/02/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

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 interview, the licensee did not comply with the section cited above in that the facility has conducted an emerency disaster drill on 8/1/23 and does not have records or recollection of a drill prior to this date which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/09/2023
	Plan of Correction
1 2 3 4	Licensee will write a Statement of Understanding and future compliance with the regulation above and send to LPA by 8/9/23.

Type B

Section Cited

CCR

82068.2(b)

Needs and Services Plan (b) If the client is to be admitted and has no restricted health condition(s) as specified in Section 82092, then, no later than 30 days after admission, the licensee shall complete a written Needs and Services Plan. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interviews and record review, the licensee did not comply with the section cited above in one (1) out of five (5) client records reviewed show a missing Needs and Services Plan in Client #1's file which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 08/09/2023
	Plan of Correction
1 2 3 4	Licensee will complete and review with C1 and responsible party the Needs and Services Plan for C1 and send LPA a copy by 8/9/23.

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: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3

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 - TOWARD INDEPENDENCE PROGRAM	FACILITY NUMBER: 401703246
	VISIT DATE: 08/02/2023

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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 did not have a Needs and Services Plan. PD says C1 was admitted in April 2023, and a Plan has not been created yet. Deficiency cited. Two (2) out of five (5) client records reviewed did not include contact information for clients' dentists and one (1) client record included the physician name, but no contact information. Technical Violation issued. Licensee will update client records and send to LPA by 8/9/23.

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 were in-compliance.

Exit interview conducted, deficiencies cited, technical violation issued, and the report and appeal rights given.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2023

LIC809 (FAS) - (06/04)

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