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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604689
Report Date: 10/16/2024
Date Signed: 10/16/2024 03:36:31 PM

Document Has Been Signed on 10/16/2024 03:36 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:PARKER VILLAFACILITY NUMBER:
374604689
ADMINISTRATOR/
DIRECTOR:		LYNN DRUMMONNFACILITY TYPE:
740
ADDRESS:629 MICHAEL STTELEPHONE:
(619) 625-6886
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY: 6CENSUS: 6DATE:
10/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Caregiver Raymond AbedozaTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Raymond Abedoza.

The facility is licensed for a maximum capacity of 6 residents, 1 ambulatory and 5 non-ambulatory, 1 of which may be bedridden in Bedroom #6. The facility has a waiver for 5 hospice residents. During today’s visit, the facility had a census of 6 residents, 1 ambulatory, 4 non-ambulatory, and 1 bedridden. The Administrator for the facility is Lynn Drummond and their certificate was pending.

During today's visit, LPA toured the facility, reviewed resident and staff records, and observed residents in care. During the facility tour, LPA observed unsecured cleaning chemicals stored in an unlocked cabinet under the kitchen sink. LPA also observed unsecured knives and scissors stored in a drawer in the kitchen that had a broken lock. LPA observed Caregiver Abedoza relocate cleaning chemicals and sharps to the facility garage which is secured by a number pad lock on the door during the visit. LPA also observed unsecured medications prescribed to a previous resident stored in the bottom of the refrigerator door. Caregiver Abedoza relocated previous resident's medications to a secured location. Due to time constraints, the annual inspection could not be completed and a return visit on a subsequent day is needed. LPA was away from the facility for approximately one hour between 12:00pm and 1:00pm.

The following deficiencies were cited for unlocked medications and unlocked hazardous items and noted on the attached LIC809-D page.

An exit interview was conducted with Caregiver Raymond Abedoza, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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 2
Document Has Been Signed on 10/16/2024 03:36 PM - It Cannot Be Edited


Created By: Rebecca A Ruiz On 10/16/2024 at 02:58 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
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: PARKER VILLA
FACILITY NUMBER: 374604689

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87465(h)(2)
87465(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines 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
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Based on observation, the licensee did not comply with the section cited above in that unsecured medications belonging to a previous resident were stored in the facility fridge which poses an immediate safety risk to 6 of 6 residents in care.
POC Due Date: 11/15/2024
Plan of Correction
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LPA observed Caregiver Abedoza relocate medications to a secured location and will be destroying those medications promptly. Abedoza stated that staff will receive a medication storage training and submit proof of training to the Department by POC due date of 11/15/2024.
Type A
Section Cited
CCR
87309(a)
87309(a) Disinfectants, cleaning solutions, poisons, firearms 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
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Based on observation, the licensee did not comply with the section cited above in that cleaning chemicals, knives, and other sharps were not locked which poses an immediate safety risk to 6 of 6 residents in care.
POC Due Date: 10/16/2024
Plan of Correction
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LPA observed Caregiver Abedoza relocate the cleaning chemicals and sharps to the facility garage which is secured by a number pad lock. Abedoza stated that staff will receive training on proper storage of dangerous and hazardous items and submit proof of training to the Department by POC due date of 11/15/2024.
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:Jennifer Lott
LICENSING EVALUATOR NAME:Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:
DATE: 10/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/16/2024


LIC809 (FAS) - (06/04)
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