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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202636
Report Date: 11/20/2024
Date Signed: 11/20/2024 02:59:05 PM

Document Has Been Signed on 11/20/2024 02:59 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:MURIEL WRIGHT RECOVERY CENTER CRTFACILITY NUMBER:
435202636
ADMINISTRATOR/
DIRECTOR:		JENNIFER BRISCOEFACILITY TYPE:
772
ADDRESS:298 BERNAL ROAD STE ATELEPHONE:
(408) 638-4744
CITY:SAN JOSESTATE: CAZIP CODE:
95119
CAPACITY: 15CENSUS: 15DATE:
11/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Jennifer BriscoeTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required - 1 Year visit and met with Administrator Jennifer Briscoe.

During visit, LPA toured the facility inside and out. LPA toured 5 resident bedrooms. Each bedroom had functioning lights and available bedding and clothing storage areas. LPA toured the resident men's bathroom and women's bathroom. Each bathroom had working lights and available soap and paper towels. The water temperatures in the bathroom sinks measured at 115 F and 112 F.

LPA toured the kitchen area and observed there to be a perishable food supply of at least 3 days and a non-perishable food supply of at least seven days. LPA toured the outside area and found the exits to be clear of obstructions. LPA reviewed the first aid kit and found it to be complete.

The Emergency Disaster Drill Log indicates the last recorded drill was conducted on 09/11/2024. Facility records indicate that contracted safety engineers inspected the fire extinguishers and smoke detectors on 07/24/2024 and determined they were operational and maintained.

LPA reviewed Centrally Stored Medication and Destruction Records (CSMDR) for residents R1-R6. R2's CSMDR had a medication that was missing a prescription label. R3's CSMDR had 2 medications missing, R4's CSMDR had had 3 medications missing, R5's CSMDR had 1 medication missing, and R6's CSMDR had 5 medications missing. LPA reviewed the resident records for R1-R6 and found them to be complete. LPA reviewed staff records for 6 staff and found them to be complete.

Deficiencies were cited as per California Code of Regulations Title 22. This report was reviewed with Administrator Jennifer Briscoe and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 11/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/20/2024
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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Document Has Been Signed on 11/20/2024 02:59 PM - It Cannot Be Edited


Created By: David Marrufo On 11/20/2024 at 02:26 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
, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: MURIEL WRIGHT RECOVERY CENTER CRT
FACILITY NUMBER: 435202636

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80075(k)(7)(A)-(H)
(k) The following requirements shall apply to medications which are centrally stored: (7) The licensee shall ensure the maintenance, for each client, of a record of centrally stored prescription medications which is retained for at least one year and includes the following: (A) The name of the client for whom prescribed. (B) The name of the prescribing physician (C) The drug name, strength and quantity. (D) The date filled. (E) The prescription number and the name of the issuing pharmacy. (F) Expiration date. (G) Number of refills. (H) Instructions, if any, regarding control and custody of the medication.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on review of records, Licensee did not ensure that 5 out of 6 reviewed resident Centrally Stored Medication and Destruction Records did not have missing medications, which poses a potential health risk to residents in care.
POC Due Date: 11/27/2024
Plan of Correction
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Licensee agrees to conduct in-service training with staff by POC date on ensuring that all medications are entered into the Centrally Stored Medication and Destruction Records. Once training is completed, the Licensee shall submit copies of training records, which shall include names of staff trained, training topic(s), and names and qualifications of trainers, to CCL by POC date.
Type B
Section Cited
CCR
80075(k)(3)
(k) The following requirements shall apply to medications which are centrally stored: (3) All medications shall be labeled and maintained in compliance with label instructions and state and federal laws.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on review of records, the Licensee did not ensure that 1 out of 6 reviewed resident medications did not include a medication that was missing its prescription label, which poses a potential safety risk to residents in care.
POC Due Date: 11/27/2024
Plan of Correction
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Licensee agrees to conduct in-service training with staff by POC date on ensuring that all medications have a prescription label. Once training is completed, the Licensee agrees to send training records, which should include names of staff trained, training date(s), and names and qualifications of trainers, to CCL by POC 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:Sarah Yip
LICENSING EVALUATOR NAME:David Marrufo
LICENSING EVALUATOR SIGNATURE:
DATE: 11/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/20/2024


LIC809 (FAS) - (06/04)
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