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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 445201743
Report Date: 10/27/2021
Date Signed: 10/27/2021 01:58:55 PM

Document Has Been Signed on 10/27/2021 01:58 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, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:ABEONA HOUSEFACILITY NUMBER:
445201743
ADMINISTRATOR:EMMA SPILLNERFACILITY TYPE:
733
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 6CENSUS: 6DATE:
10/27/2021
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Iesha RodriguezTIME COMPLETED:
03:00 PM
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On October 27, 2021, at 1:00 PM Licensing Program Analyst (LPA) Oquendo conducted an unannounced inspection to the facility for the purpose of conducting an Annual inspection. LPA Oquendo met with Residential Counselor (RC) - Iesha Rodriguez RC and LPA toured the facility, inside and out. The facility is licensed to serve six clients, ages 12-17 years. Currently in placement are six clients. Two of the six clients were present at the facility, two clients were at school and two clients were AWOL at the time of this inspection. The two clients present at the facility, declined to be interviewed.

This facility is a two story house that consists of 4 client bedrooms and 2 bathrooms. LPA Oquendo observed at the time of this inspection, the facility to be clean, safe, and sanitary. All fire alarms, and carbon monoxide detectors were in good working condition, and the fire extinguisher is current. The files are kept locked to ensure confidentiality. Food supply, linens and fire extinguisher were observed. There is sufficient perishable food for over two days and nonperishable food for over seven days. Toxins and sharps are properly stored. Medication storage and procedures were also reviewed. The following documents are posted in the facility: facility license, emergency disaster plan, facility sketch, menu, activity calendar and personal rights. The hot water temperature was at (Kitchen Sink - 119, hallway bathroom 105, and other upstairs bathroom 110 degrees).

Facility has no firearms or bodies of water at the facility which meets title 22 regulations. There are currently no exceptions on file, and there have not been any deficiencies cited in the past year.

A review of Licensing Information System on October 26, 2021 indicates that all facility staff are associated to the facility had DOJ, FBI, and child abuse index check clearances.
The annual inspection for this facility will continue on another date.
SUPERVISORS NAME: Carolyn Flynn
LICENSING EVALUATOR NAME: Daniel J Oquendo
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2021
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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