134602495-10-31-2024-08-AS-LSIA-DAKVJS-20241031162913

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 134602495
Report Date: 10/30/2024
Date Signed: 10/31/2024 04:29:59 PM

Document Has Been Signed on 10/31/2024 04:29 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:	CASA ELITE		FACILITY NUMBER:	134602495
ADMINISTRATOR/ DIRECTOR:	IRMA PINEDA		FACILITY TYPE:	740
ADDRESS:	1785 CITRUS LANE		TELEPHONE:	(760) 352-9591
CITY:	EL CENTRO	STATE: CA	ZIP CODE:	92243
CAPACITY: 8	TOTAL ENROLLED CHILDREN: 0	CENSUS: 5	DATE:	10/30/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:15 AM
MET WITH:	Licensee Irma Pineda		TIME VISIT/ INSPECTION COMPLETED:	04:15 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) Liliana Silveira conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Licensee Irma Pineda.

According to the facility’s license, the facility has a maximum capacity of 8 non-ambulatory elderly residents, three (3) of whom may be bedridden. There is a hospice waiver approved for eight (8) residents.

LPA, accompanied by Irma, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was 77 degrees F. Hot water temperature at taps accessible to clients were all compliant: Bathroom #1 sink was 116.5 F. Bathroom #2 had two sinks: #1 was 118.1 F and #2 was 118.2 F. Bathroom #3 sink was 115.8.

No pools or bodies of water were observed on the premises. Per Licensee Irma Pineda, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas. Required licensing postings were observed in visible areas of the facility. [CONTINUED ON LIC 809-C]

Robyn Clark	TELEPHONE: (619) 767-2312
Liliana Silveira	TELEPHONE: (619) 481-0844
	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

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

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: CASA ELITE	FACILITY NUMBER: 134602495
	VISIT DATE: 10/30/2024

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
26
27
28
29
30
31
32

[CONTINUED FROM LIC 809] LPA interviewed staff and residents. LPA reviewed staff and client records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained required documents. Confidential records were stored in locked areas. Irma also presented proof of current/active business liability insurance and surety bond.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored in the kitchen. Cooking/dining equipment and utensils were present.

No deficiencies were observed or cited during today's annual inspection.

An exit interview was conducted with Irma, to whom a copy of this report and Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISOR'S NAME: Robyn Clark	TELEPHONE: (619) 767-2312
LICENSING EVALUATOR NAME: Liliana Silveira	TELEPHONE: (619) 481-0844
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2