372008416-11-19-2025-08-AS-RABA-DNKT9E-20251119133149

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 372008416
Report Date: 11/19/2025
Date Signed: 11/19/2025 01:32:05 PM

Document Has Been Signed on 11/19/2025 01:32 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	VIA CALLADO		FACILITY NUMBER:	372008416
ADMINISTRATOR/ DIRECTOR:	TYRONE POWELL		FACILITY TYPE:	735
ADDRESS:	772 VIA CALLADO		TELEPHONE:	(760) 730-5082
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92057
CAPACITY: 6		CENSUS: 6	DATE:	11/19/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Administrator Tyrone "Aaron" Powell		TIME VISIT/ INSPECTION COMPLETED:	01:35 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 Borunda 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 Administrator Tyrone "Aaron" Powell. Co-Administrator Maria DeGuzman arrived during the visit. The facility has a licensed capacity of 6 ambulatory clients. During today’s visit, the facility had a census of 6 ambulatory clients. The Administrator for the facility is Tyrone Powell and their certificate was valid and current. During today’s visit, LPA inspected each room of the facility, including client and staff rooms, common bathrooms, kitchen, garage, common areas, and outside space. No bodies of water, delayed egress, or secured perimeter were observed on the premises. The facility was found to be clean, safe, and in good repair with no pathway obstructions. LPA observed linens and hygiene products for client use. The facility’s ambient and water temperature were measured within regulatory requirements at multiple locations. LPA observed locked storage for client medications which were stored separately from food supplies. LPA observed knives and sharp items which were located in unsecured drawers and in the kitchen sink and observed staff medications in the staff bedroom, which was unlocked. LPA observed staff relocate sharps to locked storage and locked the staff bedroom. According to Aaron Powell, no firearms or weapons are stored on the premises. LPA observed a minimum supply of 2-days of perishable food and 7-days of non-perishable food. The refrigerator and freezer temperatures were kept within requirements. Continued on LIC809-C page...

NAME OF LICENSING PROGRAM MANAGER: Sabel Martinez
NAME OF LICENSING PROGRAM ANALYST: Rebecca A Borunda
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: VIA CALLADO	FACILITY NUMBER: 372008416
	VISIT DATE: 11/19/2025

NARRATIVE

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LPA observed that Staff 1 (S1) did not have current criminal background clearance and interviews and records review revealed that S1 had been working at the facility since July or August 2025, and had been present at the facility for more than 5 days. LPA observed S1 leave the facility prior to the end of the visit. LPA reviewed multiple client and staff records. Client 1 (C1) was missing an physician's report and Client 2's (C2) physician report stated that C2 was non-ambulatory, however, interviews and LPA observations revealed that C2 was able to ambulate independently, did not use a walker, wheelchair, or cane, and was able to leave in case of emergency without assistance. [Administrator was provided with an LIC811 Confidential Names List to identify S1, C1, and C2]

The following deficiencies were cited for uncleared staff, unsecured dangerous/hazardous items, and client records and noted on the attached LIC809-D pages. Additionally, a civil penalty in the amount of $500 was assessed for uncleared staff and noted on the attached LIC421BG form.

An exit interview was conducted with Administrator Tyrone "Aaron" Powell, whose signature below confirms receipt of a copy of this report, the LIC421BG, and the Licensee Appeal Rights (LIC9058 3/22).

NAME OF LICENSING PROGRAM MANAGER: Sabel Martinez
NAME OF LICENSING PROGRAM ANALYST: Rebecca A Borunda
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 11/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 11/19/2025 01:32 PM - It Cannot Be Edited

Created By: Rebecca A Borunda On 11/19/2025 at 12:31 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: 11/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80087(g)

Building and Grounds

(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients. 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 that unsecured sharps and staff medications were not kept in locked storage when not in active use which poses an immediate health and safety risk to 6 of 6 clients in care.
	POC Due Date: 11/26/2025
	Plan of Correction
1 2 3 4	LPA observed staff relocate sharps to locked storage and lock the staff bedroom during the visit. Administrator stated that he will create a locked drawer in the kitchen and purchased a new doorknob for the staff bedroom. Administrator will conduct in-service training with staff regarding using locked storage. Administrator will provide pictures of the locked drawer and doorknob and a copy of the staff training sign in sheet to the Department by POC due date of 11/26/2025.

Type A

Section Cited

CCR

80019(e)

Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview, and record review, the licensee did not comply with the section cited above in that S1 was present and working at the facility prior to having current criminal background clearance which poses an immediate safety risk to 6 of 6 clients in care.
	POC Due Date: 12/19/2025
	Plan of Correction
1 2 3 4	LPA observed S1 leave the facility during the visit. Administrator understands that S1 will not be able to return to the facility until they have approved criminal record clearance. Administrator will submit a copy of S1's livescan form and receipt from fingerprinting service by POC due date of 12/19/2025.

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

	Sabel Martinez
NAME OF LICENSING PROGRAM MANAGER:

	Rebecca A Borunda
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 11/19/2025 01:32 PM - It Cannot Be Edited

Created By: Rebecca A Borunda On 11/19/2025 at 12:31 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: 11/19/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80069(b)

Client Medical Assessments

(b) In ARFs, prior to accepting a client into care, the licensee shall obtain and keep on file documentation of the client's medical assessment. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in that C1 did not have a physician's report and C2's physician's report had incorrect information which poses a potential health risk to 2 of 6 clients in care.
	POC Due Date: 12/19/2025
	Plan of Correction
1 2 3 4	Administrator will schedule appointments with C1 and C2's physicians to obtain updated physician's reports. Administrator will provide a copy of C1 and C2's updated phsycian's reports to the Department by POC due date of 12/19/2025.

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.

	Sabel Martinez
NAME OF LICENSING PROGRAM MANAGER:

	Rebecca A Borunda
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025

LIC809 (FAS) - (06/04)

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