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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 134601955
Report Date: 03/21/2022
Date Signed: 03/21/2022 07:04:35 PM

Document Has Been Signed on 03/21/2022 07:04 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:ARC IV DEVELOPMENT CENTERFACILITY NUMBER:
134601955
ADMINISTRATOR:MARIA NEGRETEFACILITY TYPE:
775
ADDRESS:298 E. ROSS AVETELEPHONE:
7603537440
CITY:EL CENTROSTATE: CAZIP CODE:
92244
CAPACITY: 85CENSUS: 31DATE:
03/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Program Director Vanisha GarciaTIME COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) Debbie Correia visited the facility to conduct an annual required licensing inspection. LPA Correia was greeted by Front Receptionist Claudia Garcia, and met with Program Director (PD) Vanisha Garcia, Human Resource Director (HSD) Mariana Torres, and Program Supervisor (PS) Julie Turner.

LPA, accompanied by facility staff, conducted an overall tour of the facility. The inspection included, but was not limited to, verifying compliance with statutes, regulations and other requirements that are most relevant to protecting the health of clients in care and staff, including in the area of infection control practices.

LPA reviewed current Community Care Licensing (CCL) guidance to incorporate in the facility’s Plan for Epidemic Outbreak Specific to COVID-19 Mitigation Plan Report (LIC 808) with PD Garcia including but not limited to the following sections: staff vaccination requirements and staff and consumer vaccination tracking, and visitation guidelines. LPA reviewed the strategies that the facility is employing for the prevention, containment and mitigation of COVID-19, implementation of infection control guidance, ability to quarantine or isolate if necessary and essential health and safety.

LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff, clients and visitors; a sign-in policy; signs posted throughout the facility to promote infection control including but not limited to hand hygiene and cough/sneeze etiquette face coverings worn by staff and as much as possible, the clients; hand sanitizer/hand washing stations readily available; emergency agencies’ contact information posted in a location visible to staff and clients; and an adequate supply of PPE. The facility is in compliance with and has implemented infection control practices as outlined in its LIC 808.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: ARC IV DEVELOPMENT CENTER
FACILITY NUMBER: 134601955
VISIT DATE: 03/21/2022
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No deficiencies were observed during today's visit. An exit interview was conducted with PD Garcia and a copy of this report along with the Licensee Rights (LIC 9058 FAS 01/16) will be provided via email to PD Garcia at the conclusion of the visit. An electronic reply response confirms receipt of these documents.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2022
LIC809 (FAS) - (06/04)
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