<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202636
Report Date: 12/13/2023
Date Signed: 12/13/2023 04:38:03 PM

Document Has Been Signed on 12/13/2023 04:38 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:JENNIFER BRISCOEFACILITY TYPE:
772
ADDRESS:298 BERNAL ROAD STE ATELEPHONE:
(408) 638-4744
CITY:SAN JOSESTATE: CAZIP CODE:
95119
CAPACITY: 15CENSUS: 13DATE:
12/13/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Jennifer BriscoeTIME COMPLETED:
04:45 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) David Marrufo conducted an unannounced Case Management visit and met with Administrator Jennifer Briscoe. The purpose of the visit was to address deficiencies reported by the Department of Health Care Services (DHCS) regarding a visit that occurred on 10/11/2023. The DHCS report stated that client records were reviewed. 3 out of 3 reviewed client rehabilitation/treatment plan records for clients C1-C3 did not contain documented evidence of specific methods to evaluate achievement goals.

A deficiency was cited as per California Code of Regulations Title 22. See LIC809-D for more information.

This report was reviewed with Administrator Jennifer Briscoe and a copy of this report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: David Marrufo
LICENSING EVALUATOR SIGNATURE: DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/13/2023
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 2
Document Has Been Signed on 12/13/2023 04:38 PM - It Cannot Be Edited


Created By: David Marrufo On 12/13/2023 at 03:19 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: 12/13/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/20/2023
Section Cited
CCR
81068.3(d)

1
2
3
4
5
6
7
81068.3 Modifications to Needs and Services Plan (d) The program director or staff person specified in (a) above shall, with the client's participation, review the treatment/rehabilitation plan according to the schedule set forth in California Code of Regulations, Title 9, Division 1,
1
2
3
4
5
6
7
Licensee agrees to review all resident treatment/rehabilitation plans and ensure that all current client treatment/rehabilitation plans contain documented evidence of specific methods to evaluate achievement goals by POC date. **Deficiency cleared during visit. Licensee has already reviewed and updated
8
9
10
11
12
13
14
Chapter 3, Article 3.5, Section 532.2(c). This requirement was not met as evidenced by: Licensee did not ensure that the treatment/rehabilitation plans of clients C1-C3 contained documented evidence of specific methods to evaluate achievement goals.
8
9
10
11
12
13
14
 all 13 current client treatment/rehabilitation plans to ensure that they contain documented evidence of specific methods to evaluate achievement goals.**

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 12/13/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2023


LIC809 (FAS) - (06/04)
Page: 2 of 2