565800394-1-6-2023-29-AS-KLOZ-CMU26T-20230106160740

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565800394
Report Date: 01/06/2023
Date Signed: 01/06/2023 04:12:23 PM

Document Has Been Signed on 01/06/2023 04:12 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:	BROWN BOARD & CARE		FACILITY NUMBER:	565800394
ADMINISTRATOR:	BETTINA BROWN		FACILITY TYPE:	735
ADDRESS:	1337 W. HILL STREET		TELEPHONE:	(805) 483-9618
CITY:	OXNARD	STATE: CA	ZIP CODE:	93033
CAPACITY: 10		CENSUS: 10	DATE:	01/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:44 AM
MET WITH:	Bettina Brown		TIME COMPLETED:	01:35 PM

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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced Required 1 Year inspection at the facility today. LPA initially met with staff and explained the reason for the inspection. Administrator Bettina Brown arrived at the facility at 10:55 AM. The LPA, along with the Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations.
Common Areas: The living room area and dining room area has sufficient seating for clients and was free of obstruction. The carbon monoxide detector and smoke alarms in the common areas and bedrooms were tested and operational. The fire extinguishers were observed be charged and last serviced on 01/06/2022. The Administrator stated they will get the fire extinguisher serviced. The washer and dryer are in the laundry and were observed to be functioning. Cleaning supplies are locked in a closet. Medications are stored in a locked closet in the office.

Kitchen: The facility has a sufficient supply of perishable and non-perishable food stored. There are two refrigerators that store food for client use, although one refrigerator is currently not working. The Administrator stated they are looking for a replacement refrigerator currently. The facility also has a separate freezer stocked with food. The refrigerator currently being used needs to cleaned and food of not good quality removed, as the LPA observed moldy cheese in the refrigerator and general disorganization of the items in the refrigerator. Kitchen knives are stored in a locked desk cabinet in the office.

Common Restrooms: There are three restrooms for client use and two staff restrooms. At 11:10 the hot water temperature in the downstairs restroom measured at 114.6 degrees F. The restrooms were found to be in operating condition with hand soap and paper towels.

Bedrooms: The five resident bedrooms were observed. All bedrooms and common areas are in need of vacuuming as debris was observed on the floor. All rooms had sufficient lighting. Report continued on LIC 809-C.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023

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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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: BROWN BOARD & CARE	FACILITY NUMBER: 565800394
	VISIT DATE: 01/06/2023

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Infection Control: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. The facility disinfects the home daily. Upon entry, the facility has a central entry point for symptom screening. LPA observed staff to be wearing a mask. The LPA observed an adequate supply of Personal Protective Equipment (PPE). If needed, the facility has the capacity to designate a single isolation room. The facility’s policies and procedures as it pertains to infection control are adequate.

The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview and report reviewed with the Administrator. A copy of the report and appeal rights were emailed to the Administrator.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 01/06/2023 04:12 PM - It Cannot Be Edited

Created By: Kasandra Lopez On 01/06/2023 at 12:38 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: BROWN BOARD & CARE	FACILITY NUMBER: 565800394
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/06/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/06/2023 Section Cited CCR 80087(a)	1 2 3 4 5 6 7	80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. The requirement is not met as evidenced by:	1 2 3 4 5 6 7	The home was vaccumed and the refrigerator was cleaned during the inspection. Plan of correction cleared.
	8 9 10 11 12 13 14	Based on observation, the licensee did not comply with the section cited above as the refrigerator is in need of cleaning and the common areas and bedrooms in need of vacuuming which poses a potential health and safety risk to clients in care.	8 9 10 11 12 13 14
	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:

Desaree Perera

LICENSING EVALUATOR NAME:

Kasandra Lopez

LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023

LIC809 (FAS) - (06/04)

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