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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372008416
Report Date: 11/01/2024
Date Signed: 11/01/2024 10:54:42 AM

Document Has Been Signed on 11/01/2024 10:54 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:VIA CALLADOFACILITY NUMBER:
372008416
ADMINISTRATOR/
DIRECTOR:		TYRONE POWELLFACILITY TYPE:
735
ADDRESS:772 VIA CALLADOTELEPHONE:
(760) 730-5082
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY: 6CENSUS: 5DATE:
11/01/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Caregiver Gina BaluyutTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced plan of correction visit. LPA was greeted by, identified herself to, and explained the purpose of the visit to Caregiver Gina Baluyut.

The purpose of today's visit was to verify if the deficiencies 80087(a) regarding building and grounds and deficiency 80070(a) regarding clients' records issued on 10/1/2024 had been corrected. On 10/1/2024, the licensee was issued two deficiencies with a correction due date of 10/25/2024. On 10/7/2024, LPA Ruiz received an email from the facility with medication training for staff attached. Review of the training documents revealed that the training met the POC for deficiency 80070(a). Therefore, the deficiency 80070(a) regarding client records has been corrected by the POC due date.

During today’s visit, LPA Ruiz toured the facility and observed the backyard. LPA Ruiz was able to visually confirm that the licensee removed two sheds in the backyard and had secured items in locked cabinets or had thrown away clutter that had been stored in the backyard. Therefore, the deficiency 80087(a) regarding building and grounds has been corrected by the POC due date.

An exit interview was conducted with Caregiver Gina Baluyut, whose signature below confirms receipt of a copy of this report, the POC clearance letter, and the Licensee Appeal Rights (LIC9058 3/22).
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2024
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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