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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202636
Report Date: 09/30/2024
Date Signed: 09/30/2024 03:40:37 PM

Document Has Been Signed on 09/30/2024 03:40 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: 12DATE:
09/30/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:45 PM
MET WITH:Jennifer BriscoeTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct a case management - other visit. LPA met with Clinical Director, Kevin Scurich and Administrator, Jennifer Briscoe.

The purpose of the visit is to address Title 22 violations reported by the Department of Health Care Services (DHCS) annual visit that occurred on 08/22/2024.

The DHCS report stated that 2 out of 3 client open records contained a written assessment that was not completed on admission. 3 clients records contained a written assessment that did not include documented evidence of medical needs, as reported.

The DHCS report stated that 5 personnel records did not contain documented evidence that the employees had one (1) year of full-time experience, or its part-time equivalent, working in a program serving persons with mental disabilities or a documented plan of supervision.

LPA reviewed the facility's plan of correction verbally with the Clinical Director and obtained the facility's written plan of correction that was submitted to DHCS.

Deficiencies were cited per California Code of Regulations, Title 22. See LIC809-D.

This report was reviewed with Clinical Director, Kevin Scurich and Administrator, Jennifer Briscoe and a copy of the report and appeal rights was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2024
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 09/30/2024 03:40 PM - It Cannot Be Edited


Created By: Christine Dolores On 09/30/2024 at 03:00 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: 09/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2024
Section Cited
CCR
81068.2(b)(1)

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(b) For each client admitted, the licensee shall ensure that a written Needs and Services Plan is started prior to admission, and completed prior to or within 72 hours of admission, that must include: (1) A written assessment as required in California Code of Regulations, Title 9, Division 1, Chapter 3, Article 3.5, Section 532.2(b). This requirement is not met as evidenced by:
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Deficiency cleared during visit. Licensee corrected the deficiency prior to visit by implementing a plan to conduct daily audits of the clients assessments in the EHR system to ensure the assessments are completed within the required timeframe.
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Based on record review the licensee did not ensure 2 clients contained a written assessment completed on admission and 3 clients contained a written assessment that did not document evidence of medical needs which poses a potential health, safety, and personal rights
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Type B
09/30/2024
Section Cited
CCR81065(n)

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(n) All direct care staff shall meet the minimum qualifications as set forth in California Code of Regulations, Title 9, Division 1, Chapter 3, Article 3.5, Sections 532.6(h) and (i). This requirement is not met as evidenced by:
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Deficiency cleared during visit. Licensee corrected the deficiency prior to visit by updating resumes for 3 staff members to include specific experience with mental health and 2 staff members has a plan of supervision.
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Based on record review the licensee did not ensure 5 personnel records contained documented evidence of required experience or a documented plan of supervision which poses a potential health, safety, and personal rights risk to persons in care.
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Going forward, licensee will review staff resumes prior to work and input them into a tracker to mark whether or not a plan of supervision is required and track completion of the plan as needed.
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:Christine Dolores
LICENSING EVALUATOR SIGNATURE:
DATE: 09/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2024


LIC809 (FAS) - (06/04)
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