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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372008416
Report Date: 07/06/2023
Date Signed: 07/06/2023 03:59:53 PM

Document Has Been Signed on 07/06/2023 03:59 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:VIA CALLADOFACILITY NUMBER:
372008416
ADMINISTRATOR:TYRONE POWELLFACILITY TYPE:
735
ADDRESS:772 VIA CALLADOTELEPHONE:
(760) 730-5082
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY: 6CENSUS: 5DATE:
07/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:35 PM
MET WITH:Administrator Tyrone "Aaron" PowellTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced case management visit to address a deficiency observed during an unrelated complaint visit. LPA identified herself to, was greeted by, and explained the purpose of the visit to Administrator Tyrone "Aaron" Powell.

During today's visit, LPA Ruiz observed the Administrator's private room located at the back of the facility was under construction. Interviews revealed that the construction began on the room roughly 2 months ago and was still underway. Interviews revealed that the Administrator did not inform the Department prior to the construction beginning. The construction does not interfere with the clients' daily routine and does not affect any client access to their bedrooms or bathrooms.

LPA issued a Technical Violation (TV) regarding reporting requirements for alterations and construction.

An exit interview was conducted with Administrator Tyrone "Aaron" Powell, whose signature below confirms receipt of a copy of this report, the LIC9102TV, and the Licensee Appeal Rights (LIC9058 01/16).
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/06/2023
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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