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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600397
Report Date: 07/12/2022
Date Signed: 07/21/2022 07:54:21 AM

Document Has Been Signed on 07/21/2022 07:54 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:LYN'S HOME CARE IIFACILITY NUMBER:
374600397
ADMINISTRATOR:LYDIA S. ABILLEFACILITY TYPE:
735
ADDRESS:1365 EL LUGAR STREETTELEPHONE:
(619) 427-1830
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 6CENSUS: 6DATE:
07/12/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:13 PM
MET WITH:Caregiver, Victoria AzucenaTIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an unannounced annual required licensing inspection. LPA was granted entry by Caregiver, Victoria Azucena after identifying herself and disclosed the purpose of the visit. An overall tour of the facility was conducted inside and out. The inspection included, but was not limited to, verifying compliance with statutes, regulations and other written requirements that are most relevant to protecting the health of clients in care and staff, including in the area of infection control practices.

LPA reviewed the facility’s Plan for Epidemic Outbreak Specific to COVID-19 Mitigation Plan Report (LIC 808) with Caregiver, Victoria Azucena including the following sections: Person in Care, Staff, Visitors, Facilities without COVID-19, Clients, Facility has Plans for Infection Control and Physical Distancing. LPA assessed the strategies that the facility is employing for the prevention, containment and mitigation of COVID-19, implementation of infection control guidance, staff retention and essential health and safety.

LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff, clients and visitors; signs throughout the facility to promote hand hygiene, cough/sneeze etiquette and physical distancing; face coverings worn by staff; hand sanitizer/hand washing stations readily available; a designated visitation area; emergency agencies’ contact information posted in a location visible to staff and clients; and an adequate supply of PPE. The facility in in compliance with and has implemented infection control practices as outlined in its LIC 808.

Based on today’s inspection, no deficiencies were observed. An exit interview was conducted with Caregiver, Victoria Azucena. A copy of this report, along with the Licensee Rights (9058 01/16) was printed and provided to Caregiver, Azucena at the facility.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Elizabeth Hamilton
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2022
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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