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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372008410
Report Date: 10/25/2024
Date Signed: 10/25/2024 01:49:08 PM

Document Has Been Signed on 10/25/2024 01:49 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:TODOS SANTOS ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
372008410
ADMINISTRATOR/
DIRECTOR:		JOHN DURKEEFACILITY TYPE:
735
ADDRESS:959 TOMORRO LANETELEPHONE:
(760) 723-6273
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY: 6CENSUS: 4DATE:
10/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:30 PM
MET WITH:Administrator, David ValenzuelaTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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On 10/25/2024, Licensing Program Analyst (LPA), Janette Romero made an unannounced visit to conduct a required annual inspection at the facility. LPA was greeted and granted entry by Administrator, David Valenzuela who was informed of the purpose of the visit. The facility has a fire clearance for six (6) ambulatory adults ages 18 through 59.

LPA toured the facility with Administrator Valenzuela and observed the facility is made up of a one-story home with three (3) client bedrooms, two (2) bathrooms, a living room, kitchen, dining room, and attached garage. LPA was informed the four (4) clients currently residing in the home were attending day program during LPA's visit. Administrator Valenzuela tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA also observed two (2) charged fire extinguishers in the kitchen. LPA toured the kitchen and observed the facility has a two-day supply of perishable foods and seven-day supply of non-perishable food items, which are stored in a safe and healthful manner. Medications and knives are secured in a locked hallway closet. Cleaning solutions and disinfectants are secured in the locked garage. There are no bodies of water on the premises and indoor and outdoor passageways were free of obstruction. LPA reviewed random client files and noted they had updated Individual Program Plans and signed admission agreements. LPA reviewed the Record Of Client's/Resident's Safeguarded Cash Resources (LIC405) for the current clients while Administrator Valenzuela counted their physical monies, and no discrepancies were discovered. Complaint procedures, emergency contact information and resident rights are visibly posted in the dining room.

During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted and a copy of this report was reviewed and provided to Administrator Valenzuela.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2024
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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