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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 371881409
Report Date: 08/23/2024
Date Signed: 08/23/2024 10:40:36 AM

Document Has Been Signed on 08/23/2024 10:40 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
FACILITY NAME:AVID BEHAVIORAL DAY PROGRAM-CAPALINAFACILITY NUMBER:
371881409
ADMINISTRATOR/
DIRECTOR:		MARCELIN, SARAIFACILITY TYPE:
775
ADDRESS:1637 CAPALINA RDTELEPHONE:
(858) 442-6840
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY: 120CENSUS: 38DATE:
08/23/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Sarai Marceline, LicenseeTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced collateral visit to the daty program . LPA Lopez identified herself and was granted entry by Mark McLees, Direct Care Staff. LPA stated the purpose of the visit with Maribel Nambo, Administrator. Licensee Sarai Marceline later arrived and joined the visit.

During the visit, LPA Lopez spoke with staff and requested and obtained relevant records to aid in an open investigation involving a different licensed care facility. No deficiencies were observed during today's visit.

An exit interview was conducted, and a copy of this report along with Licensee/Appeal Rights (LIC9058 03/22) were provided to Licensee Sarai Marceline, at the conclusion of the visit. The signature below confirms the receipt of the documents.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2024
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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