565801817-10-10-2022-29-AS-AASO-CK3W4C-20221010165720

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801817
Report Date: 10/10/2022
Date Signed: 10/10/2022 04:58:59 PM

Document Has Been Signed on 10/10/2022 04:58 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:	CREATING OPPORTUNITIES & VOCATIONAL ENTERPRISES		FACILITY NUMBER:	565801817
ADMINISTRATOR:	JUDITH FLICKNER		FACILITY TYPE:	775
ADDRESS:	2041 CABOT PLACE		TELEPHONE:	(805) 988-6508
CITY:	OXNARD	STATE: CA	ZIP CODE:	93030
CAPACITY: 60		CENSUS: 37	DATE:	10/10/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:10 PM
MET WITH:	Judith Flickner		TIME COMPLETED:	02:25 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) Angel Ascencio conducted an unannounced required annual visit to the facility above. LPA Ascencio met with the Administrator Judith Flickner and explained the reason for the visit. At 12:14 p.m., the LPA, along with the Admin toured the physical plant areas inside and outside to ensure that there are no health and safety hazards. RESTROOMS: There are four (4) total bathrooms at the facility. One (1) is designated as a shower bathroom. The client bathroom has a shower with non-skid materials. The toilet and showers have grab bars. The hot water temperature was tested in the bathrooms and kitchen. Areas were found to be within the range of 105F and 120F. COMMON SPACES/ACTIVITY SPACE: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating area and dining room furniture was observed to be in good condition. Chairs were observed to be at least 6 (six) feet apart for social distancing. The LPA observed the required postings in the common hallway. The fire extinguisher was observed to be serviced within the last year. The facilities smoke detectors and carbon monoxide alarms were tested throughout the facility and seemed to work properly at the time of visit. LPA received the 5-Year Inspection, Testing and Maintenance from CINTAS Fire Protection dated 12/21/2018. Medication was observed to be locked and contained 30 days of medication. There were no bodies of water noted. KITCHEN: Kitchen knives are stored in the locked cabinet in the office. The supply of dishes, utensils, pots, pans and drink ware is adequate. The freezer was maintained at zero degrees Fahrenheit (0F) and the refrigerator was maintained at 40F. The supply of nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Continued on LIC 809-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022

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 10/10/2022 04:58 PM - It Cannot Be Edited

Created By: Angel Ascencio On 10/10/2022 at 01:02 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: CREATING OPPORTUNITIES & VOCATIONAL ENTERPRISES	FACILITY NUMBER: 565801817
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/10/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

82087(a)(3)

Buildings and Grounds

(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (3) Disinfectants, cleaning solutions, poisons, and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as Lysol Disinfectant spray, Purell Hand wipes, poly-urethan paint, and woodstain was found accesible to clients which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/11/2022
	Plan of Correction
1 2 3 4	Admin stated they will conduct all staf trainng on 82087(a)(3). Admin will submit documentation of material and attendee to CCL by 10/14/2022.

Type A

Section Cited

CCR

82075(l)(1)

Health-Related Services

(l) The following requirements shall apply to medications which are centrally stored: (1) Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above as Viatmin B-12 and Metformin 850mg was accesible to clients which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 10/11/2022
	Plan of Correction
1 2 3 4	Admin stated they will conduct training on 82075(I)(1). Admin will submit documentation of material and attendee to CCL by 10/14/2022.

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:

Kristin Heffernan

LICENSING EVALUATOR NAME:

Angel Ascencio

LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022

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: CREATING OPPORTUNITIES & VOCATIONAL ENTERPRISES	FACILITY NUMBER: 565801817
	VISIT DATE: 10/10/2022

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Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen, laundry and house cleaning supplies are stored in a locked cabinet located in a locked closet in the hallway. No flies or other vermin were observed.

INFECTION CONTROL: During today’s visit, the LPA spoke with the Admin regarding the
facility’s infection control practices at 12:50 p.m. There are 2 entry into the facility. Upon entry, the
facility has a central entry point for symptom screening. The LPA noted that the facility is allowing
visitors for both indoor and outdoor visitation. The LPA observed an adequate supply of Personal
Protective Equipment (PPE) and the facility is able to obtain additional supplies as needed. The
facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility does not have a confirmed case of COVID-19 at this time. The facility’s policies and procedures as it pertains to infection control are adequate.

During facility tour, starting at 12:25 p.m., LPA observed Vitamin B-12, Metformin 850 MG and Lysol Disinfecting wipes on a table accessible to clients in care. Staff stated it is a staff medication and they know it should be locked up not accessible to clients. At 12:30 p.m., LPA observed Lysol Disinfectant spray, Purell Hand Sanitizing wipes, Poly-Urethane Paint and Wood Stain in a cart accessible to clients. Staff stated we have a locked closet that we should keep all these items locked away. Staff got to comfortable as they all know if should be locked away.

The following recommendations were made:
- Best practice includes one central entry point with close proximity access to visitor screening
- Post COVID - 19 Fliers and hand hygiene in restroom and within facility

2 citations were issued during today’s visit. The following deficiencies were observed (See
LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California
Health and Safety Code. Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted. A copy of the report and appeal rights were provided to admin via email.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angel Ascencio
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022

LIC809 (FAS) - (06/04)

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