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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600663
Report Date: 10/04/2024
Date Signed: 10/04/2024 03:41:42 PM

Document Has Been Signed on 10/04/2024 03:41 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:DOWNSTOWN VIIFACILITY NUMBER:
374600663
ADMINISTRATOR/
DIRECTOR:		ELISSA CIAVERELLIFACILITY TYPE:
735
ADDRESS:2808 FOOTHILL DRIVETELEPHONE:
(760) 598-1668
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY: 4CENSUS: 6DATE:
10/04/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Executive Director Kecia StinnettTIME VISIT/
INSPECTION COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Sara Martinez arrived unannounced to conduct a health and safety visit at the facility to follow up on a fire that took place at facility Downstown IV (372008467) on 09/24/2024 at approximately 2:15pm. LPA met with Executive Director Kecia Stinnett and Assistant Executive Director Sue Laubach who were informed of the purpose of the visit.

The fire occurred at 2:15pm on 09/24/2024 due to a possible breaker fire located on the external side of the house near the garage. During the fire only C1 was at the facility with House Manager Angela Ramirez. Neighbor contacted 911 and alerted House Manager Ramirez of the fire on the external part of the home. House Manager Ramirez secured C1 and evacuated the home. San Marcos Fire Inspector did a walk through of the facility and could not confirm if the fire was from either the breaker box or the gas meter located right next to each other. Licensee is waiting for the restoration company to provide cost of restoration and permits to submit to insurance to begin reconstruction.
During the time of the visit LPA conducted a health and safety check on the facility clients. Client One (C1) and Client Two (C2) were residing at Downstown IV but due to the fire was relocated to this facility. LPA observed Client One (C1) and Client Two (C2) return home from day program. LPA observed no health or safety issues during the time of the visit.

A tour of the facility was conducted and LPA observed Facility has one staff room and three client bedrooms. The client bedrooms have room for two beds in each room with enough space for clients. LPA observed the facility had working utilities and was operating as usual. LPAs observed adequate staffing to provide care for the residents. LPAs observed the facility had a two (2) day supply of perishable foods and seven (7) day supply of non-perishable food for the clients in care. LPA observed medication for six (6) clients.

An exit interview was conducted with Executive Director Stinnett where this report was reviewed and provided.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Sara Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2024
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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