134604232-12-14-2023-08-AS-AROS-CYESWM-20231211131435

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 134604232
Report Date: 12/11/2023
Date Signed: 12/14/2023 01:32:50 PM

Document Has Been Signed on 12/14/2023 01:32 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:	JACKSON HOUSE EL CENTRO		FACILITY NUMBER:	134604232
ADMINISTRATOR:	CAROLINA NUNEZ-GARCIA		FACILITY TYPE:	772
ADDRESS:	2364 SOUTH 2ND STREET		TELEPHONE:	(760) 237-9769
CITY:	EL CENTRO	STATE: CA	ZIP CODE:	92243
CAPACITY: 16		CENSUS: 11	DATE:	12/11/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Carolina Nunez-Garcia		TIME COMPLETED:	01:30 PM

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Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Required Annual Inspection. This facility offers short-term acute residential treatment services for individuals diagnosed with mental health issues. The facility file was reviewed prior to the visit. LPA was greeted and allowed entry into the facility by Program Director, Carolina Nunez-Garcia, to whom LPA discussed the purpose of the visit. The facility serves sixteen (16) mentally disabled adults ages 18 through 59 years; all of whom may be ambulatory. During the inspection, there was a total of 11 (eleven) clients in care, all of whom are ambulatory.

LPA, accompanied by Program Director, Nunez-Garcia, 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, 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 compliant. Hot water temperature at taps accessible to clients were all compliant.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas.

[CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023

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: JACKSON HOUSE EL CENTRO	FACILITY NUMBER: 134604232
	VISIT DATE: 12/11/2023

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[CONTINUED FROM LIC 809-C]

No pools or bodies of water on the premises. Per Program Director, Nunez-Garcia, no firearms or ammunition are kept at the facility. signal system is complaint, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were in working order. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA interviewed staff and clients. LPA interviews did not raise any licensing concerns. LPA reviewed multiple staff and client records/files. Files reviewed contained required documents. Confidential records were stored in locked areas. Program Director, Nunez-Garcia presented proof of current/active business liability insurance. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs

An exit interview was conducted with Program Director, Nunez-Garcia to whom copies of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 12/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023

LIC809 (FAS) - (06/04)

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