405800432-3-25-2024-29-AS-RDLN-D3PS4P-20240325133305

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 405800432
Report Date: 03/25/2024
Date Signed: 03/25/2024 01:33:18 PM

Document Has Been Signed on 03/25/2024 01:33 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 - SENIORS		FACILITY NUMBER:	405800432
ADMINISTRATOR:	DEBORAH ARGANO		FACILITY TYPE:	775
ADDRESS:	9465 MORRO ROAD		TELEPHONE:	(805) 466-0527
CITY:	ATASCADERO	STATE: CA	ZIP CODE:	93422
CAPACITY: 30		CENSUS: 7	DATE:	03/25/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Program Director Rachel Santos		TIME COMPLETED:	01:45 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	Licensing Program Analyst (LPA) De Leon arrived at 10:45am to conducted a 1 year annual visit to the facility above. LPA met with Program Director Rachel Santos and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted. The following was inspected and noted during the annual visit: Infection Control: The Adult Day Program (ADP) has submitted a current Infection Control Plan to the department. The facility has a sign in and out binder for visitors at entry. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. Quarantined or isolated individuals will placed in isolation room until picked up from program. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). All trash cans and waste baskets have tight fitting covers. Physical Plant & Environmental Safety: The facility has A large day room for activities, 1 Staff office, Quiet room, Locked Storage room, Kitchen with Microwave, Stove, and Refrigerator, snack cabinet, and 2 restrooms, Staff room with locked medication cabinet. Outside shaded area for client use. The Adult Day Program currently occupying 7 clients and employs 4 staff, and 1 Administrator. The facility is clean, safe and sanitary. LPA was authorized to enter and inspect facility. The facility has smoke alarms and 1 carbon monoxide detector. The lighting is sufficient for the use of the facility and for clients comfort. The facility kitchen is clean, safe and sanitary. Toilet and hand washing facilities are operational. The pathways are clear of any obstructions. Disinfectant, cleaning solutions and poisons are inaccessible to clients in care locked in supply closet. The facility has sufficient space inside for activities and visiting. The facility has telephone and internet service for clients. Water temperatures were checked in bathroom #1 at 107.3 degrees F. Continued 809-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024

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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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 - SENIORS	FACILITY NUMBER: 405800432
	VISIT DATE: 03/25/2024

NARRATIVE

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Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility is approved for a capacity of 30 and 10 can be Non-Ambulatory clients.

Staffing: The facility employes 4 staff and 1 Administrator. Staff records are kept confidential. LPA reviewed 5 staff files for 1st AID/CPR, Finger print clearances, Applications, Health exam with TB results, Criminal Record statement and Administrator file was reviewed for continuing education of 30 hour every 2 years. Administrator has 19.5 hours on file. Administrator will email LPA a copy of the LIC 503 with TB results.

Personnel Records & Training: The facility keeps confidential files for each staff member. 4 staff had current 1st AID/CPR, Records were present, up to date and kept confidential. Initial and Annual Training requirements are being met. All staff files had 8 plus hours of Annual training for 2023-2024.

Clients Rights: All require postings were posted in the common areas of the program. The License is posted.

Clients Records & Incident Reports: The facility keeps separate files on each client confidentially. Five files were reviewed for signed Admission Agreements, Medical Assessments LIC. 602A Physicians Report, ID and Emergency contact forms, Appraisal Needs and Services plans (ANS) with IPP or ISP which are completed quarterly and/or annually, TB results, Personal Rights. The Facility does not handles cash resources for clients in care. The ADP does not have property or valuables kept at day program. Facility does submit incident reports to the department when required.

Food Service: THE ADP has a kitchen with stove, microwave, and refrigerator on the premises. Lunch and snacks are brought to program by clients. The facility can provide snacks/drinks if clients do not bring from home. The facility handles and prepares food safely. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees. All food is covered, stored and marked appropriately. Emergency supply of food and water is available. Cleaning solutions and equipment are stored separately than food supply. Kitchen areas are kept clean and free from litter, rodents, vermin and insects. Drinking water is available to all clients. Continued 809-C

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024

LIC809 (FAS) - (06/04)

Page: 2 of 5

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 - SENIORS	FACILITY NUMBER: 405800432
	VISIT DATE: 03/25/2024

NARRATIVE

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Health Related Services: Facility provides Centrally Stored Medications to 1 client in care. LPA reviewed 1 clients medication, no labels altered, no expired medications and medications are being kept in the original container. First Aid is provided to clients in care. The facility Keeps medications locked.

Incidental Medical Services: The ADP contacts clients responsible parties for medical and dental services. The ADP uses the Centrally Stored Medication and Destruct Record (CSMDR) along with a calendar for daily accounting of medications given.

Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts disaster drills every 6 months. The fire extinguishers were charged and last inspected 02/12/2024. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full program in an emergency.

Emergency Intervention: The facility does not use manual restraint or seclusion on any clients in care and is not required to take the CPI training.

LPA conducted interviews with 2 staff and 2 clients.

Exit interview conducted and copy of report printed for Administrator.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2024

LIC809 (FAS) - (06/04)

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