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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600611
Report Date: 01/05/2024
Date Signed: 01/05/2024 10:43:47 AM

Document Has Been Signed on 01/05/2024 10:43 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:HOOVER ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
374600611
ADMINISTRATOR:ELAINE CORVILLAFACILITY TYPE:
735
ADDRESS:1150 HOOVER STREETTELEPHONE:
(760) 294-3069
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY: 6CENSUS: 6DATE:
01/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:41 AM
MET WITH:ADMINISTRATOR, ELAINE CORVILLATIME COMPLETED:
10:50 AM
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On January 05, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the required annual inspection and met with the Administrator, Elaine Corvilla introduced herself, and stated the purpose of the visit. The facility file review was conducted in the office and at the facility.

LPA Mixson toured the facility along with the Administrator and inspected the facility inside and outside, and there were no obstructions to the indoor or outdoor passageways at the time of this visit. The facility: is licensed for six Adult Residents and is operating at full capacity currently at the time of this visit.
Physical Plant: the facility is a single story home located at 1150 Hoover St. Escondido, CA. 92027, and the facility phone number is (760) 294-3069, and is operable. The LPA observed the six bedrooms, and they were equipped with required furniture as per Title 22 Regulations. The bathrooms were inspected and the hot water temperature was tested and tested within regulations and logged by the Administrator. The bathrooms were clean and appliances were operating appropriately currently at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and a fire extinguisher. The LPA observed required postings such as "If you See Something, Say Something" the "Personal Rights" and the "Ombudsman" postings were posted in a common area. The cleaning supplies and sharp items were kept locked and inaccessible to the residents in care. There was a designated storage space for the resident and staff files it was locked and inaccessible to residents in care. Medications: the medications were reviewed, locked and inaccessible to residents, and there was a 30 day supply. The overall facility is clean, the furniture is in good condition. The facility heating system and other appliances were operable currently at the time of this visit, and the facility temperature read 74 degrees at the time of the visit. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for the residents. Dishes and utensils were in sufficient supply and stored properly. Care & Supervision Facility has sufficient staff, two staff currently, and five at the time of this visit. The other resident is in the community. Records Review: The LPA reviewed six resident files, and two staff files, and conducted two staff interviews, and two resident interviews, and observed the remaining residents. Previous Community Care Licensing forms were reviewed. There were no Title 22, Division 6 Regulation violations observed or cited during today’s visit. An exit interview was conducted and a copy of this report was given to the Administrator, Elaine Corvilla.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 01/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/05/2024
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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