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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600838
Report Date: 12/12/2023
Date Signed: 12/12/2023 04:52:04 PM

Document Has Been Signed on 12/12/2023 04:52 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:NALAS RESIDENTIAL FACILITY #1FACILITY NUMBER:
374600838
ADMINISTRATOR:HUBER BARQUEROFACILITY TYPE:
735
ADDRESS:1926 OLIVEBROOK CT.TELEPHONE:
(619) 401-5247
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY: 6CENSUS: 6DATE:
12/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Luis Alpizar, CaregiverTIME COMPLETED:
02:15 PM
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Licensing Program Analysts (LPA) Mark Mandel and Daniel Pena, conducted the Required Annual inspection. Facility file was reviewed prior to inspection. LPA Mandel was granted entry into the facility by Caregiver, Luis Alpizar. LPA's identified themselves and stated the purpose of the inspection. The facility serves six developmentally disabled adults, and currently has six clients in care. There is no secured perimeter.

LPAs were accompanied by Caregiver, Alpizar, during a tour of the facility, conducted inside and out. During today’s inspection, the facility temperature was measured at 73 degrees F. Carbon monoxide detector and smoke alarms were operational and met statutory standards. No pools or bodies of water were observed. Exterior and interior passageways were free from obstructions. According to Caregiver Alpizar, there are no weapons and/or ammunition stored on the premises. Disinfectants, cleaning solutions are inaccessible to clients, and poisons are locked. There are sufficient lamps or lights in all rooms.

Each client had clean linen in good repair and sufficient hygiene products for personal use. All clients’ rooms were equipped with required furnishings to meet their needs. Clients’ bathrooms contain the required furnishings and were in a safe, sanitary, and operational condition. Hot water temperature at faucets for clients’ use were measured at 113.4 degrees and 114 degrees Fahrenheit.

Facility has a two-day supply of perishable and a seven-day supply of nonperishable food items. Food was observed to be properly stored. Medications were stored in a safe and locked place and were labeled and kept in compliance with label instructions.

(Cont on LIC809)
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Mark Mandel
LICENSING EVALUATOR SIGNATURE: DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/12/2023
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: NALAS RESIDENTIAL FACILITY #1
FACILITY NUMBER: 374600838
VISIT DATE: 12/12/2023
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Staff records review verified that all staff have a current First Aid, Criminal Record Clearance, Criminal Record Statement, and staff training. Resident records reviewed for a current Physician's Report, Resident Appraisal, Needs & Services Plan (IPP), Admissions Agreement, and Centrally Stored Medication. Clients’ cash resources are stored independently of other clients and facility funds. Surety bond is on file and bonded for the appropriate amount. The facility conducts emergency drills regularly and the last one was conducted in October 2023. Emergency disaster plan was reviewed. Administrator’s certification expires on 01/06/2024.

Based on today’s inspection, no deficiencies were observed at this time in the areas evaluated. An exit interview was conducted and a copy of this report and Licensee Rights - LIC 9058 (rev. 01/16) were provided to Caregiver, Luis Alpizar, whose signature on this form acknowledges receipt of these documents.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Mark Mandel
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
LIC809 (FAS) - (06/04)
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