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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600008
Report Date: 04/27/2023
Date Signed: 04/27/2023 03:24:52 PM

Document Has Been Signed on 04/27/2023 03:24 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:DOWNSTOWN VIFACILITY NUMBER:
374600008
ADMINISTRATOR:ELISSA CIAVERELLIFACILITY TYPE:
735
ADDRESS:2248 TIERRA VERDETELEPHONE:
(760) 599-9762
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY: 4CENSUS: 3DATE:
04/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Executive Director, Kecia StinnettTIME COMPLETED:
03:30 PM
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Licensing Program Analysts (LPAs) Janira Arreola and Sara Martinez conducted an unannounced annual required visit on 4/27/2023 at 01:50 p.m. LPA was granted entry and met with Executive Director, Kecia Stinnett, who was informed of the purpose of the visit. At the time of the visit there was (3) staff and (0) client present.

The facility is a two story home with (4) bedrooms and (3) bathrooms with attached garage. No pools or firearms are being kept at the facility. The clients served are adults between the ages of 18-59. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted staff interviews. LPA observed the following:

Physical Plant: LPA observed the client bedrooms. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. LPA observed outdoor furniture for clients. Laundry equipment was observed to be in good working condition. The sharp and dangerous objects were observed to be unlocked in a kitchen drawer. No clients were present at the time of the visit, and staff locked the drawer immediately. Technical note was documented for this. The smoke and carbon monoxide detectors were operational, and the hot water temperature was recorded at 118.5F.



Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods.

Care & Supervision/Administration: Adequate staff are present for the supervision of clients during the visit. LPA also reviewed the staff scheduled showing adequate staff coverage. The listed administrator, possesses a current administrator's certificate.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: DOWNSTOWN VI
FACILITY NUMBER: 374600008
VISIT DATE: 04/27/2023
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Due to time constraints the annual inspection was unable to be completed on this date. LPA Arreola will return on a later date to complete the inspection. The staff was informed of this matter.

No deficiencies were cited at the time of the visit.

An exit interview was conducted where a copy of this report was provided to the Executive Director, Kecia Stinnett.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2023
LIC809 (FAS) - (06/04)
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