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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370803192
Report Date: 08/17/2021
Date Signed: 08/17/2021 01:36:48 PM

Document Has Been Signed on 08/17/2021 01:36 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 OF SAN DIEGO-SOL AND RUTH GERBER FAMILY CENTERFACILITY NUMBER:
370803192
ADMINISTRATOR:LILIANA DOLBAIAFACILITY TYPE:
775
ADDRESS:1280 NOLAN AVENUETELEPHONE:
(619) 427-7524
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 186CENSUS: 23DATE:
08/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:46 AM
MET WITH:Program Administrator, Susana Levack and Senior Director of Adult Day Services, Melanie McCoyTIME COMPLETED:
11:50 AM
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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an annual required licensing inspection. This annual inspection was focused on infection control due to the COVID-19 pandemic. LPA gained access to the facility and met with Program Administrator, Susana Levack and Senior Director of Adult Day Services, Melanie McCoy. LPA discussed the purpose of the visit. This day program serves one hundred eighty-six (186) adults ages 18 and above; fifty (50) of whom may be non-ambulatory in room.

During today's visit, LPA toured the facility, and verified compliance with infection control practices. LPA, Levack and McCoy reviewed the facility’s COVID-19 Mitigation Plan. LPA observed one central entry point; routine symptom screening initiated at entry for staff, clients and visitors; a sign-in policy enacted for all visitors; signs throughout the facility to promote hand hygiene, face coverings worn by staff; hand sanitizer/hand washing stations readily available; a designated visitation area; emergency agencies’ contact information posted in a location visible to staff and clients; and an adequate supply of PPE and disinfectants. LPA discussed the Provider Information Notice (PIN) regarding updated guidance on face coverings and moving the sign in log to the main entrance.

Based on today's visit, no deficiencies were observed in the areas evaluated above. An exit interview was conducted with Levack and McCoy and a copy of this report along with the Licensee/Appeal Rights (LIC 9058) was provided via email. An electronic receipt of confirmation was requested to be sent by the Licensee upon receipt of the documents.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Elizabeth Hamilton
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2021
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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