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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 500300344
Report Date: 10/29/2024
Date Signed: 10/29/2024 05:00:47 PM

Document Has Been Signed on 10/29/2024 05:00 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:HOWARD PREPFACILITY NUMBER:
500300344
ADMINISTRATOR/
DIRECTOR:		BRANDIE MONTESFACILITY TYPE:
775
ADDRESS:1424 STONUM ROADTELEPHONE:
(209) 538-4000
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY: 320CENSUS: 24DATE:
10/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Brandie Montes, AdministratorTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
NARRATIVE
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On 10/29/24, Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to complete an annual inspection. LPA Campbell met with Administrator Brandie Montes and explained the purpose of the visit. Upon entry, LPA Campbell was greeted by the administrator and lead to a well lit work space clear of debris.

During a tour of the facility, LPA Campbell observed clients were active in organized classrooms and that hallways were clear of obstruction. LPA Campbell measured the temperature of water in the bathroom. The water was found to 122 degrees Fahrenheit (F) which is within the required range of 105 and 120 degrees F. Of the 10 staff files reviewed, LPA Campbell confirmed that 1 of the staff were not fingerprint cleared or associated to the facility and 1 of the staff did not have verification of a negative TB test. Of the 24 clients registered at the facility, LPA Campbell reviewed 4 files and found them to be complete.

The smoke and carbon monoxide alarm were connected to the fire department. When asked, staff were unable to access the fire drill logs because the health and safety manager was absent. However, LPA Campbell was able to review a facility Health and Safety Inspection for the current month and the facility Infection Control Plan. The administrator presented verification of their current certification and were found to be in compliance.

Based on today's inspection, per the California Code of Regulations, Title 22, Division 6, Chapter 6, deficiencies were observed or cited and noted on LIC 809D. Note that failure to correct any deficiencies will result in additional civil  penalties.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Renee Campbell
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
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 3
Document Has Been Signed on 10/29/2024 05:00 PM - It Cannot Be Edited


Created By: Renee Campbell On 10/29/2024 at 03:53 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HOWARD PREP
FACILITY NUMBER: 500300344

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80064(a)(4)

(a)(4) Ability to maintain or supervise the maintenance of financial and other records.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the licensee did not comply with the section cited above in 1 of 3 requests for documentation which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 11/08/2024
Plan of Correction
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Administrator will provided a statement of understanding of for regulation 80064(a)(4) and verify how and when they will have access to fire drill logs and status of staff fingerprint clearance.
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:Lisa Rios
LICENSING EVALUATOR NAME:Renee Campbell
LICENSING EVALUATOR SIGNATURE:
DATE: 10/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/29/2024


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 10/29/2024 05:00 PM - It Cannot Be Edited


Created By: Renee Campbell On 10/29/2024 at 04:14 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
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HOWARD PREP
FACILITY NUMBER: 500300344

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82019(e)(2)
(e) Prior to working, residing or volunteering in a licensed day program, all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall do the following:
(2) Obtain a California clearance or a criminal record exemption as required by the Department
This requirement is not met as evidenced by:

Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 out of 10 staff file reviews which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/08/2024
Plan of Correction
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Administrator will ensure any staff moving forward will be associated to the facility prior to working a shift and provide verification that all staff are cleared by POC due day. Administrator to review regulation 82019, guardian, and finger print transfer procedures. Administrator to send a written statement acknowledging understanding of regulation and procedure to LPA by POC due date.
Type A
Section Cited
CCR
82065(g)(1)
82065(g)(1) The good physical health of each employee and individual licensee shall be verified by... negative test results for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on file review, the licensee did not comply with the section cited above in 1 of 10 files reviewed which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/08/2024
Plan of Correction
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Licensee will ensure that any staff without TB results will remain off the facility premises and that all staff have TB results on file 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:Lisa Rios
LICENSING EVALUATOR NAME:Renee Campbell
LICENSING EVALUATOR SIGNATURE:
DATE: 10/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/29/2024


LIC809 (FAS) - (06/04)
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