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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 371881379
Report Date: 12/12/2024
Date Signed: 12/12/2024 02:49:23 PM

Document Has Been Signed on 12/12/2024 02:49 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:A&R RESIDENTIAL CARE IIFACILITY NUMBER:
371881379
ADMINISTRATOR/
DIRECTOR:		JAZMIN, ROBERTFACILITY TYPE:
735
ADDRESS:812 ALBERT COURTTELEPHONE:
(858) 204-5715
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY: 4CENSUS: 4DATE:
12/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:50 PM
MET WITH:Robert Jazmin-DirectorTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Debbie Palacios made an unannounced visit to conduct the required annual inspection. LPA was greeted at the door by Lead Caregiver Sanito Velena and explained the purpose of the visit. Administrator Oikay Ho and Director Robert Jazmin arrived shortly. LPA was informed the three (3) other clients that reside at the home were at day program; there was one (1) client in care at the time of the visit. A tour of the facility was conducted inside and out. The facility is approved for four (4) Ambulatory clients; adults ages 18-59.
The facility is a one story 4 bedroom 2 bathroom home; one (1) bedroom is designated for live-in staff. LPA observed clients bedroom furnishings to be in good repair with adequate lighting. Furniture throughout the house was observed to be in good condition. Clients have clean linen in good repair and sufficient hygiene products to meet their needs. All required postings are placed in a prominent area; facility sketch, exit routes, personal rights, and emergency phone numbers were found posted in the facility. Facility's Administrator/Director certificate was noted to be active until 05/28/2026. Facility has multiple operating dual smoke alarms and carbon monoxide detector that meet statutory standards. Fire extinguisher was examined and determined to be in compliance dated 05/23/24. All inside and outside passageways are clear of obstructions. There are no pools or bodies of water observed.
LPA observed the kitchen area to be clean and odor free with sufficient dishes and glassware. A two day supply of perishable, and a seven day supply of non-perishable, food items were observed. Hot water was measured at 116.0 degrees F. Chemicals and poisons are stored in a locked cabinet located in the laundry room. Staff and client records were reviewed and a staff interview was conducted as well.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2024
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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: A&R RESIDENTIAL CARE II
FACILITY NUMBER: 371881379
VISIT DATE: 12/12/2024
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Staff files reviewed include but not limited to have personnel records, health screenings, criminal record clearance, required training, and valid first aid/CPR certification. Clients files included but are not limited to signed admission agreements, pre-placement, personal rights, house rules, needs and service plans, and updated physician reports.

During today's visit, LPA did not observe any immediate violations or concerns. An exit interview was conducted, and a copy of this report was reviewed and provided.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2024
LIC809 (FAS) - (06/04)
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