405801490-8-17-2023-29-AS-DCHZ-CUSTBR-20230817143535

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 405801490
Report Date: 08/17/2023
Date Signed: 08/17/2023 02:36:17 PM

Document Has Been Signed on 08/17/2023 02:36 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:	FRANCISCAN RESIDENCE, THE		FACILITY NUMBER:	405801490
ADMINISTRATOR:	FRANCYN JOYCE ALTAMIRA		FACILITY TYPE:	735
ADDRESS:	4130 LOBOS AVENUE		TELEPHONE:	(805) 462-8512
CITY:	ATASCADERO	STATE: CA	ZIP CODE:	93422
CAPACITY: 4		CENSUS: 4	DATE:	08/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:48 AM
MET WITH:	Francyn Altamira, Administrator		TIME COMPLETED:	02:50 PM

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On 8/17/23 at 11:48 am, Licensing Program Analyst (LPA) Chavez conducted an unannounced Annual/Required visit to the facility listed above. LPA met with Francyn Altamira, Administrator, and explained the purpose of the visit.

LPA toured the facility with the administrator. There were no clients in the facility during the visit. Administrator states they are at day program. The facility is maintained in conformity with state fire marshal regulations. The smoke detectors and carbon monoxide detector were tested and functioning properly. Fire extinguishers (2) were located in the entry and laundry room. Extinguishers were fully charged and last inspected on 4/12/23. There are no pools or bodies of water and no firearms or dangerous weapons stored. Hot water temperatures were recorded in two resident bathrooms and the kitchen. Temperatures registered between 107.7 F and 108.6 F degrees. All toilets and hand washing facilities are maintained in a safe, sanitary, operating condition. The facility is clean, safe, sanitary and in good repair for the safety and well-being of clients, employees, and visitors. One exception is that the exterior of windows have a build-up of spider webs. Licensee will clean and send photos to LPA by 8/24/23. Each client is accorded safe, healthful, and comfortable accommodations, furnishings and equipment to meet his/her needs. There is a minimum 2-day supply of perishables and 7-day supply of nonperishable foods. Food is stored and prepared in a safe and healthful manner. Disinfectants, cleaning solutions and poisons are inaccessible to clients. The facility has adequate emergency supplies and first aid supplies. Facility temperature is 80 F degree. Outdoor walkways are free from obstruction and the facility has outside covered patio areas for individuals to use. The gates on the south (1) and north (2) sides of the property are not closing properly. The gates latch only when pushed and are not self-closing. Licensee will fix the gates’ movement and auto-closing mechanisms, take videos, and send to LPA by 8/24/23. The south side porch has a rusty nail protruding from a board on the steps. Licensee will remove/fix and send photo to LPA by 8/24/23.

Continued on 809-C.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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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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: FRANCISCAN RESIDENCE, THE	FACILITY NUMBER: 405801490
	VISIT DATE: 08/17/2023

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LPA reviewed (5) staff files for criminal record clearances and associations, Health screening with TB results, and current First Aid/CPR. Staff records reviewed are in-compliance.

The facility has an Emergency Disaster Plan (LIC 610D), however, Section H, page 5 was not completed. Licensee will complete and send to CCL by 8/24/23. Technical violation issued. Emergency disaster drills are conducted quarterly.

LPA reviewed four (4) client files for current health records, needs and services plans, signed admission agreements and personal rights. Three out of four clients' functional capabilities assessments were not signed by clients or responsible parties. Licensee will obtain signatures and send copies to CCL by 8/24/23. Technical violation issued.

Clients’ centrally stored medications are kept in a locked cabinet in the dining room. Medications are given as prescribed by doctors’ orders.

Exit interview conducted, technical violations issued, and the report given.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

LIC809 (FAS) - (06/04)

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