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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 371881367
Report Date: 03/20/2024
Date Signed: 03/20/2024 12:24:41 PM

Document Has Been Signed on 03/20/2024 12:24 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:AVID BEHAVIORAL DAY PROGRAM - CIVICFACILITY NUMBER:
371881367
ADMINISTRATOR:MAHARAJ, LORENAFACILITY TYPE:
775
ADDRESS:510 CIVIC CENTER DR SUITE ETELEPHONE:
(858) 442-6840
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY: 15CENSUS: 11DATE:
03/20/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Sarai Marcelin, COOTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to continue the Annual Inspection. Upon arrival LPA was greeted by facility staff and granted entry. Upon arrival LPA learned that eleven (11) clients are present at this facility and there are currently five (5) staff.

LPA Delgado attempted to interview three (3) clients. Three (3) staff were interviewed.

Food Service- Food prep areas are clean and organized. Snacks food items are stored inside the office. Emergency food and water supply is present. There is a locked location for chemicals inside the bathroom that was observed unlocked. No sharps are in the kitchen, use of disposable plastic ware only and sharps for office use are locked inside office.



Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility is maintained at a comfortable temperature for the participants. Lighting is sufficient for safety and comfort. Water temperature measured 108.5 degrees F. There are no Laundry facilities. All outdoor and indoor passageways are free of obstruction. There is a telephone working at this location. The LIC 610, emergency disaster plan is maintained. There are no firearms at this facility.

(Continued on next page)
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2024
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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Document Has Been Signed on 03/20/2024 12:24 PM - It Cannot Be Edited


Created By: Yolanda Delgado On 03/20/2024 at 11:37 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: AVID BEHAVIORAL DAY PROGRAM - CIVIC
FACILITY NUMBER: 371881367

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82087(a)(3)
Buildings and Grounds
(a) The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (3) Disinfectants, cleaning solutions, poisons, and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Delgado's observation and interview, the licensee did not comply with the section cited above in the common bathroom has a keypad closet that has chemicals and cleaning products stored was observed by LPA and Licensee to be unlocked. which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/21/2024
Plan of Correction
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Licensee will train staff on locking and securing the door after each entry and exit. Licensee will place signage on the door and submit training to LPA by POC Due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Jazmond D Harris
LICENSING EVALUATOR NAME:Yolanda Delgado
LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/20/2024 12:24 PM - It Cannot Be Edited


Created By: Yolanda Delgado On 03/20/2024 at 11:37 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: AVID BEHAVIORAL DAY PROGRAM - CIVIC
FACILITY NUMBER: 371881367

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/20/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82088(b)
Fixtures, Furniture, Equipment, and Supplies
(b) All window screens shall be in good repair and be free of insects, dirt and other debris.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA Delgado's observation, interview, the licensee did not comply with the section cited above in three (3) window screens need to be replaced which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/21/2024
Plan of Correction
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Licensee will obtain new window screens and send pictures by email to LPA by POC due date.
Section Cited
Deficient Practice Statement
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3
4
POC Due Date:
Plan of Correction
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4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Jazmond D Harris
LICENSING EVALUATOR NAME:Yolanda Delgado
LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2024


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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: AVID BEHAVIORAL DAY PROGRAM - CIVIC
FACILITY NUMBER: 371881367
VISIT DATE: 03/20/2024
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(Continued from previous page)

LPAs made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguisher was last inspected 01/13/2024 . The facility is conducting emergency disaster/fire drills monthly; last done on 03/6/2024.

Based on the information received during this visit today in the areas reviewed, there are two deficiencies are being cited per Title 22, Division 6 of The California Code of Regulations.

This LIC 809, 809-C, 809D, Civil penalities issued for $500 and appeal rights was reviewed with facility representative.

*Day Program had to be evacuated due to alarm not resetting; Vista Fire Department responded. Delay back into building for 1 1/2 hrs.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE:

DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024
LIC809 (FAS) - (06/04)
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