<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 134601955
Report Date: 03/27/2024
Date Signed: 03/27/2024 03:07:54 PM

Document Has Been Signed on 03/27/2024 03:07 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:ARC IV DEVELOPMENT CENTERFACILITY NUMBER:
134601955
ADMINISTRATOR:MARIA NEGRETEFACILITY TYPE:
775
ADDRESS:298 E. ROSS AVETELEPHONE:
(760) 353-7440
CITY:EL CENTROSTATE: CAZIP CODE:
92244
CAPACITY: 85CENSUS: 22DATE:
03/27/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Sheri Gutierrez, Day Program SupervisorTIME COMPLETED:
03:25 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) Carmen Lopez conducted an unannounced required annual inspection and in conjunction conducted this case management visit at the day program. LPA Lopez identified herself and was granted entry by receptionist Maggie Bravo. LPA stated the purpose of the visit and reviewed the basic elements of the visit with Day Program (DP) Supervisor, Sherry Gutierrez.

During today’s visit, LPA provided the DP Supervisor consultation and provided additional information regarding the Department’s website, Records to be Maintained at the Facility – Adult Residential (LIC 311C), Changes to Administrator Certification Training Requirements (PIN 23-14-CCLD), Criminal Background Clearance Transfer Request (LIC9182) and Criminal Record Exemption Transfer Request (LIC 9188) Form Updates (PIN 23-08-CCLD, Residential Care Facilities for the Elderly Reference Guide to Administrator, Staff, and Volunteer Training Requirements (PIN 23-16-ASC), Revised Infection Control Regulations and Permanent Adoption (PIN 23-12-ASC), and 2023 Chaptered Legislation Affecting Adult and Senior Care Facilities: Summary and Implementation (PIN 23-19-ASC).

No deficiencies were observed or cited during this case management visit. An exit interview was conducted with Day Program Supervisor Sherri Gutierrez and a copy of this report, and Licensee/Appeal Rights (LIC 9058 3/22) were provided to the DP Supervisor at the conclusion of the visit. The signature below confirms the documents were received.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2024
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 1