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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372004506
Report Date: 07/27/2022
Date Signed: 07/27/2022 03:39:56 PM


Document Has Been Signed on 07/27/2022 03:39 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
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:CARPEL BOARD & CARE FACILITY #2FACILITY NUMBER:
372004506
ADMINISTRATOR:CARMONA, LEONOR P.FACILITY TYPE:
740
ADDRESS:2091 HANFORD DRIVETELEPHONE:
(858) 569-1691
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY:6CENSUS: 6DATE:
07/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:38 PM
MET WITH:Leonor CarmonaTIME COMPLETED:
02:50 PM
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Licensing Program Analyst (LPA) Daniel Pena visited the facility and conducted an unannounced Required 1 - Year inspection. The facility file was reviewed prior to the visit. LPA was greeted by, identified himself to, and explained the purpose of the visit to Caregivers, Concepcion Lopez and Helen Nerizon. LPA was granted entry into the facility. Licensee, Leonor Carmona arrived and participated in the inspection. All staff that were present have a current criminal record clearance.

During today's visit, LPA toured the facility and verified compliance with infection control practices. LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff, clients and visitors and a sign-in policy enacted for visitors. Infection control related signs to promote hand hygiene, cough/sneeze etiquette, symptom and transmission awareness were observed. LPA discussed fit-testing staff for N-95 respirators. Staff wore face coverings and hand sanitizer/hand washing stations were readily available. LPA observed an available visitation area and the facility had an ample supply of cleaning products and PPE. The facility will request N-95 respirators from the Regional Office.

No deficiencies were cited during today’s visit. An exit interview was conducted with Licensee, Carmona and a copy of this report and Licensee Rights (LIC 9058 FAS 01/16) was provided at the facility.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 07/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/27/2022
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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