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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372004242
Report Date: 12/17/2021
Date Signed: 12/20/2021 10:13:48 AM

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:CARPEL BOARD AND CARE FACILITYFACILITY NUMBER:
372004242
ADMINISTRATOR:CARMONA, LEONORFACILITY TYPE:
740
ADDRESS:2073 HANFORD DRIVETELEPHONE:
(858) 262-4394
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY:6CENSUS: 6DATE:
12/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Leonor CarmonaTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPA was greeted by and allowed entrance into the facility by Caregiver Soledad Suba. LPA identified herself and explained the purpose of the visit to Administrator Leonor Carmona.

LPA conducted a tour of the facility and observed the clients in care. In accordance with the Department’s Infection Control, LPA provided technical assistance, observed, and evaluated the facility's implementation of their COVID-19 Mitigation Plan, to include disinfection, testing, vaccination, screening protocols, and the use of personal protective equipment.

No deficiencies were cited or observed on this date. An exit interview was conducted with Administrator Leonor Carmona, to whom a copy of this report and the licensee appeal rights (LIC9058 01/16) were provided via E-mail.
SUPERVISOR'S NAME: Alexandre VoTELEPHONE: (619) 385-7506
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2021
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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