372008416-11-15-2023-08-AS-RARZ-CXLVVZ-20231115154709

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 372008416
Report Date: 11/15/2023
Date Signed: 11/15/2023 03:47:15 PM

Document Has Been Signed on 11/15/2023 03:47 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 CALLADO		FACILITY NUMBER:	372008416
ADMINISTRATOR:	TYRONE POWELL		FACILITY TYPE:	735
ADDRESS:	772 VIA CALLADO		TELEPHONE:	(760) 730-5082
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92057
CAPACITY: 6		CENSUS: 5	DATE:	11/15/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Co-Administrator Maria DeGuzman		TIME COMPLETED:	03:50 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	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, identified herself to, and explained the purpose of the visit with Co-Administrator Maria DeGuzman. The facility is licensed for a maximum capacity of 6 ambulatory clients. During today’s visit, the facility had a census of 5 ambulatory clients. The facility does not have a clearance for delayed egress or secured perimeter and LPA did not observe any aspects of delayed egress or secured perimeter. The Administrator for the facility is Tyrone Aaron Powell and their certificate was valid and current. During today’s visit, LPA toured the facility and inspected each room of the facility, including client rooms, bathrooms for client and staff use, kitchen, garage, common areas, and outside space. No bodies of water were observed near or on the premises. According to the Co-Administrator, no firearms or weapons are stored on the premises. The facility was found to be clean, safe, and in good repair with no pathway obstructions. The facility’s water temperature was measured at 133.0 degrees Fahrenheit in a common bathroom. Facility staff adjusted the water heater and the water was remeasured at 115.3 degrees Fahrenheit. The facility’s internal temperature was measured at 70 degrees Fahrenheit. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. LPA also observed locked storage for client medications and client and staff files. Client medications are stored in their original container and label. LPA observed a 2-day supply of perishable food and a 7-day supply of non-perishable food present at the facility. The facility refrigerator was kept at 40 degrees Fahrenheit, and the facility freezer was kept at 0 degrees Fahrenheit. LPA observed linens and hygiene products provided to the clients that are in good repair and sufficient to meet their needs. Staff present at the facility during the time of the inspection had a criminal background clearance, were associated to the facility, and had a first aid certificate. Continued on LIC809-C page...

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: VIA CALLADO	FACILITY NUMBER: 372008416
	VISIT DATE: 11/15/2023

NARRATIVE

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LPA reviewed multiple client and staff records. Each client record was complete and contained a signed admission agreement, updated physician’s report and medical assessment, documents regarding safeguarding personal property and cash resources, and personal rights. LPA reviewed clients’ personal and incidental money and ledger with the Co-Administrator and did not discover any inconsistencies. Each staff file was complete and contained a personnel record, first aid certificate, fingerprint clearance and association, and a health screening. LPA spoke with staff and clients present at the facility during the time of the inspection and those interviews did not reveal any licensing or regulatory concerns.

The Co-Administrator will submit copies of the LIC500 Personnel Report, LIC610D Emergency Disaster plan, and the surety bond to the Department within 10 business days.

The following deficiency was cited per California Code of Regulations Title 22 and noted on the attached LIC809-D page.

An exit interview was conducted with Co-Administrator Maria DeGuzman, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 01/16).

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/15/2023 03:47 PM - It Cannot Be Edited

Created By: Rebecca A Ruiz On 11/15/2023 at 03:15 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: VIA CALLADO	FACILITY NUMBER: 372008416
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/15/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80088(e)(1)

(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in the common facility bathroom which poses a potential safety risk to 5 of 5 persons in care.
	POC Due Date: 11/30/2023
	Plan of Correction
1 2 3 4	The Co-Administrator adjusted the facility water heater during the LPA's inspection. Co-Administrator stated that she will purchase a thermometer, create a water temperature log, and have staff check the water temperature in the bathroom every other day. Co-Administrator will submit a copy of the water temperature log to the Department by POC due date of 11/30/2023.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Lizzette Tellez

LICENSING EVALUATOR NAME:

Rebecca A Ruiz

LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2023

LIC809 (FAS) - (06/04)

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