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Department of
SOCIAL SERVICES

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 ELITEFACILITY NUMBER:
134602495
ADMINISTRATOR/
DIRECTOR:
IRMA PINEDAFACILITY TYPE:
740
ADDRESS:1785 CITRUS LANETELEPHONE:
(760) 352-9591
CITY:EL CENTROSTATE: CAZIP CODE:
92243
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 5DATE:
10/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:15 AM
MET WITH:Licensee Irma PinedaTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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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 ClarkTELEPHONE: (619) 767-2312
Liliana SilveiraTELEPHONE: (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)
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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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: CASA ELITE
FACILITY NUMBER: 134602495
VISIT DATE: 10/30/2024
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[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 ClarkTELEPHONE: (619) 767-2312
LICENSING EVALUATOR NAME: Liliana SilveiraTELEPHONE: (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)
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