374600582-10-9-2024-08-AS-MGCO-D9W3JV-20241009181809

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374600582
Report Date: 10/09/2024
Date Signed: 10/09/2024 06:20:42 PM

Document Has Been Signed on 10/09/2024 06:20 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:	SEA BREEZE HOME & CARE II		FACILITY NUMBER:	374600582
ADMINISTRATOR/ DIRECTOR:	CATHERINE H. COFFMAN		FACILITY TYPE:	735
ADDRESS:	1231 16TH STREET		TELEPHONE:	(619) 424-9486
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92154
CAPACITY: 4		CENSUS: 4	DATE:	10/09/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	02:00 PM
MET WITH:	Administrator, Catherine Coffman		TIME VISIT/ INSPECTION COMPLETED:	04:00 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) Marisela Garcia-Centeno conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA identified herself and was granted entry by House Manager, Ana Kairuz and Administrator, Catherine Coffman to whom she disclosed the purpose of the visit. According to the facility’s license, the facility has a maximum capacity of four (4) clients, of which all must be ambulatory. During today’s inspection, there were a total of four (4) clients in care, of which four (4) clients were ambulatory. The facility does not feature a secured perimeter or delayed egress doors. LPA, accompanied by Caregiver, Merlita Pegues, toured the interior and exterior of the facility, and inspected the rooms. The facility was clean and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. The doors, toilet, and shower were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s internal temperature and refrigerator and freezer temperatures were within the regulatory range. During today’s visit, LPA observed, via measurement with a thermometer, was within the regulatory range, at 112 degrees. There were at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. There was plenty of food for clients at the facility. Cooking/dining equipment and utensils were present. There were no sharp objects, or toxic chemicals/poisons, accessible to clients. Medications were labeled, as required and stored in locked areas. Confidential records were appropriately stored. No pools or bodies of water were observed on the premises. (continue at LIC809C

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

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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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: SEA BREEZE HOME & CARE II	FACILITY NUMBER: 374600582
	VISIT DATE: 10/09/2024

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(continue from LIC809)

Per the licensee, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher was serviced within the last 12 months, on October 4, 2024. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA interviewed staff and present during the visit and reviewed staff and client records. The three (3) clients were out in the community and not available for an interview. LPA interviews did not raise any licensing concerns. The client files that LPA reviewed contained the required documents. Staff records contained proof of current first aid training, as the last training for which certification was maintained was on 10/31/2022 and it expires on 10/21/2024. Licensee planning to have first aid training on 10/11/2024 for all staff. Licensee presented proof of current/active business liability insurance and current surety bond. Fire/Emergency drill was conducted on October 1, 2024 at 5:30 p.m. The emergency drills are performed once a month.

No deficiencies were cited during today's visit. An exit interview was conducted with Licensee, Coffman, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the end of the visit.

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2024

LIC809 (FAS) - (06/04)

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