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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425801652
Report Date: 08/29/2023
Date Signed: 08/29/2023 05:17:25 PM

Document Has Been Signed on 08/29/2023 05:17 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:SOLVANG FRIENDSHIP HOUSE-ADPFACILITY NUMBER:
425801652
ADMINISTRATOR:TAMMY WESTWOODFACILITY TYPE:
775
ADDRESS:880 FRIENDSHIP LANETELEPHONE:
(805) 688-8748
CITY:SOLVANGSTATE: CAZIP CODE:
93463
CAPACITY: 15CENSUS: 10DATE:
08/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:18 AM
MET WITH:Tammy Westwood, Administrator, and Aisa Coronel, Life Enrichment Day Program CoordinatorTIME COMPLETED:
05:30 PM
NARRATIVE
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On 8/29/23 at 10:18 am, Licensing Program Analyst (LPA) Chavez conducted an unannounced Annual/Required visit to the facility listed above. LPA met with Tammy Westwood, Administrator, and Aisa Coronel, Life Enrichment Day Program Coordinator, and explained the purpose of the visit.

LPA toured facility with the administrator and day program coordinator. 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 and carbon monoxide detectors are hardwired. Between 12:06 pm and 12:15 pm, hot water temperatures in the client bathroom and kitchenette measured between 122.2 F and 122.8 F degrees. Deficiency cited. 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, beverages, and meals are provided to clients. Food is stored and prepared in a safe and healthful manner. At 11:40 am, LPA observed an unlocked drawer with knives in the unlocked kitchen. LPA observed an unlocked first aid kit in an unlocked cabinet in the kitchen. LPA observed an unlocked kitchen staff office with approximately five new knives in the unlocked desk drawer. Also, observed was an unlocked beauty parlor with toxic beauty supplies. Kitchen, staff office, and beauty parlor areas are accessible to clients. Deficiency cited. The kitchen stove and oven need cleaning so as to prevent a potential fire. Administrator agreed to have it cleaned, take photos, and end to LPA by 9/5/23. Facility has adequate emergency and first aid supplies. Fire extinguishers (3) are located in the large activity room near the kitchenette, in the kitchen, and in the hall near the laundry room. Extinguishers were fully charged and last inspected on 3/9/23. Facility temperature is 70 degrees.

Continued on 809-C.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE: DATE: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/29/2023
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 08/29/2023 05:17 PM - It Cannot Be Edited


Created By: Darlene Chavez On 08/29/2023 at 04:30 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: SOLVANG FRIENDSHIP HOUSE-ADP
FACILITY NUMBER: 425801652

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82075(f)
Health-Related Services
(f) Staff responsible for providing direct care and supervision shall receive and maintain current training in first aid and cardiopulmonary resuscitation from persons qualified by agencies including, but not limited to, the American Red Cross.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interviews, the licensee did not comply with the section cited above in that three out of five staff records reviewed show that staff do not have current first aid certificates. Four out of five staff records reviewed indicate that staff do not have current CPR certificates which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/12/2023
Plan of Correction
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Administrator has agreed to get all staff scheduled for training to be completed by 9/12/23 and send copies of the certiicates to LPA by the due date.
Type B
Section Cited
CCR
82075.2(a)(3)(C)
Automated External Defibrillators (AEDs)
(a) A licensee is permitted to maintain and operate an AED at the day program if all of the following conditions are met: (3) The licensee shall maintain at the program site the following: (C) A copy of a valid AED operator's certificate for any employee(s) authorized by the licensee to operate the AED. The certificate shall indicate that the AED training course completed complies with the standards of the American Heart Association or the American Red Cross. If it does not, then other evidence indicating that the AED training course completed complies with the standards of the American Heart Association or the American Red Cross shall be available at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interviews, the licensee did not comply with the section cited above in Zero out five staff files reviewed show that staff are not certified in AED which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/12/2023
Plan of Correction
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Administrator has agreed to get all staff scheduled for training to be completed by 9/12/23 and send copies of the certiicates to LPA by the due date.
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: 08/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2023


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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: SOLVANG FRIENDSHIP HOUSE-ADP
FACILITY NUMBER: 425801652
VISIT DATE: 08/29/2023
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Outdoor walkways are free from obstruction and the facility has fenced areas outside. Centrally stored medications are locked in a file cabinet in the coordinator’s locked office and inaccessible to clients. The Centrally Stored Medications are recorded and filed in a locked cabinet in the coordinator’s office. LPA observed sufficient staff to client ratio. Emergency disaster drills are being conducted quarterly and the last drill was on 8/4/23.

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 four out five client files did not have dentist contact information in their files. Technical violation issued.

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. TB results and clearances/associations are completed. Three out of five staff records reviewed show that either staff do not have first aid certification or their certification has expired. Four out of five staff records reviewed indicate that staff do not have CPR certification or their certification has expired. Deficiency cited. Five out of five staff files reviewed indicate that staff do not have AED certificates or the certifications have expired. Deficiency cited.

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: 08/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2023
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 08/29/2023 05:17 PM - It Cannot Be Edited


Created By: Darlene Chavez On 08/29/2023 at 04:52 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: SOLVANG FRIENDSHIP HOUSE-ADP
FACILITY NUMBER: 425801652

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/29/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82088(e)(1)
(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 is 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 that three out of four faucets measured temperatures over 120 F degree which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/05/2023
Plan of Correction
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Administrator agreed to adjust the water temperatures to be in compliance and send LPA videos of water being tested by the POC due date.
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: 08/29/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2023


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