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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405800432
Report Date: 02/15/2023
Date Signed: 02/15/2023 12:28:07 PM

Document Has Been Signed on 02/15/2023 12:28 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 - SENIORSFACILITY NUMBER:
405800432
ADMINISTRATOR:DEBORAH ARGANOFACILITY TYPE:
775
ADDRESS:9465 MORRO ROADTELEPHONE:
(805) 466-0527
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY: 30CENSUS: 11DATE:
02/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:53 AM
MET WITH:Rachel Santos, Program DirectorTIME COMPLETED:
12:40 PM
NARRATIVE
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On 2/15/23 at 10:53 am, Licensing Program Analyst (LPA) Chavez conducted an unannounced on-site annual infection control visit to the facility above. LPA met with Rachel Santos, Program Director, and explained the purpose of the visit.

LPA toured the facility with the program director and observed the following: The facility has signage at the front door regarding the visitor policy. Screening, hand sanitizer, and visitor log was available at the entryway. There is a large common area/activity room and two client bathrooms. Both bathrooms are equipped with soap and paper towels. At 11:10 am, the water temperature in the bathroom near the entry was recorded at 128F degrees, and at 11:16 am, the water temperature in the bathroom near the back entrance was recorded at 129.9F degrees. Water temperatures are not in compliance of the regulatory 105F to 120F degrees. Deficiency cited. The facility has signage for COVID infection control measures including cough etiquette and handwashing reminders. There are three fire extinguishers, one at the entry, one in the staff breakroom, and the last in the garage. The fire extinguishers are fully charged and inspected on 2/10/23. LPA observed all staff wearing proper face coverings.

At 11:30 am, LPA conducted the Infection Control mitigation module with the program director.

Exit interview conducted and report given to the program director.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2023
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 02/15/2023 12:28 PM - It Cannot Be Edited


Created By: Darlene Chavez On 02/15/2023 at 12:09 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 - SENIORS
FACILITY NUMBER: 405800432

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82088(e)(1)
Fixtures, Furniture, Equipment, and Supplies: (e) Faucets used by clients for personal care shall deliver hot water. (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 was not met as evidenced by:
Deficient Practice Statement
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Based on testing, the licensee did not comply with the section cited above in two of the two bathroom faucets whose water temperature was recorded between 128F and 129.9F degrees which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/16/2023
Plan of Correction
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Licensee will adjust the water temperature to comply with the regulation, take a video and send to LPA by end of day 2/16/23.
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:Kelly Burley
LICENSING EVALUATOR NAME:Darlene Chavez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2023


LIC809 (FAS) - (06/04)
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