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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 405801767
Report Date: 08/07/2024
Date Signed: 08/07/2024 02:09:46 PM

Document Has Been Signed on 08/07/2024 02:09 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:OPTIONS COMMUNITY INTEGRATION SERVICES-MORRO BAYFACILITY NUMBER:
405801767
ADMINISTRATOR/
DIRECTOR:		CHRISTINA HUTCHISONFACILITY TYPE:
775
ADDRESS:840 MORRO AVENUE, SUITE ATELEPHONE:
(805) 772-1019
CITY:MORRO BAYSTATE: CAZIP CODE:
93442
CAPACITY: 30CENSUS: 23DATE:
08/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:TIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Rankin arrived at 9:05 am to conduct a 1-year annual visit to the facility above. LPA met with Kristin Hodge, Acting General Manager (GM(A)), and explained the purpose of the visit.

A tour of the inside and outside of the facility was conducted with GM(A). The following was inspected and noted during the annual visit:

Infection Control: 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 sufficient supply of PPE and is able to obtain more from their main office if needed.

Physical Plant & Environmental Safety: The facility is a day program with 2 restrooms and 3 sufficient sized areas to serve clients during day activities. They currently serve 27 clients. The facility has smoke and carbon monoxide detectors both tested and working. The lighting and lamps are sufficient for staff and clients. The facility does not have a kitchen. The facility refrigerator is clean and operating at required temperature. Toilet and hand washing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Disinfectant, cleaning solutions and poisons are inaccessible to clients in care locked in cabinet in the activity area. The facility has sufficient space inside and outside for activities and visiting. Water temperature was checked in restroom , they were found to be within required regulation levels, temperature is checked monthly.

Continued 809-C
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: OPTIONS COMMUNITY INTEGRATION SERVICES-MORRO BAY
FACILITY NUMBER: 405801767
VISIT DATE: 08/07/2024
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Staffing: The facility currently employes 7 staff and 1 Administrator. Staff records are kept confidential in the HR office located within 30 minutes of the facility. Human Resources uploaded documents for LPA review. LPA reviewed 5 random staff files. Files reviewed had current 1st Aid/CPR certificates with the expectation of one staff member. A copy of the instructor certification along with their documented Training Completion Report were provided to prove approved trainer signed off on course completion. Other documents reviewed were Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Fingerprint clearance/Associations/exemptions. All records were complete.

Personnel Records & Training: The facility keeps confidential files on staff training. LPA reviewed staff training records of 8 hours of annual training. Training is done monthly during all staff meetings. Signatures of all staff were present for various appropriate topics.

Clients Rights information: All required postings were posted in the common area of the facility. Personal rights, Community Care Licensing Complaint poster which was posted at entry.

Clients Records & Incident Reports: The facility keeps separate files on each client confidential. 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) which facility utilizes the Individual Services Plan (ISP) and contains the same information and is completed annually, TB results, Personal Rights. The Facility does not handle cash resources for any clients in care.

Food Service: The facility does not have a kitchen. The clients bring a packed lunch and snacks from home. If a client forgets to bring their lunch, the facility staff will provide something from a local store to provide to the clients while at day program.

Continued 809-C
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: OPTIONS COMMUNITY INTEGRATION SERVICES-MORRO BAY
FACILITY NUMBER: 405801767
VISIT DATE: 08/07/2024
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Health Related Services: First Aid is provided to clients in care as needed.

Incidental Medical Services: Facility provides transportation or arranges transportation to medical and dental appointments if needed coordinates with clients’ homes for pick up or transportation. The day program does not do medications for clients in care, medications are given at home prior to coming to program or after attending day program.

Disaster Preparedness: The emergency disaster forms were posted and updated to reflect current staffing. Advised facility to update and add the updated registration of client’s roster to their binder for emergency situations. The facility conducts quarterly disaster drills. The fire extinguishers were charged and last inspected 06/24/2024. A set of keys is available for staff on all shifts to access full facility in an emergency.

Emergency Intervention: The facility is a hands-off facility and does not use manual restraint or seclusion with any clients in care.

Exit interview conducted, copy of report printed for General Manager to provide to administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Melisa Rankin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2024
LIC809 (FAS) - (06/04)
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