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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600882
Report Date: 11/19/2021
Date Signed: 11/19/2021 02:16:51 PM

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:EDWARD'S RESIDENTIAL CENTER-1FACILITY NUMBER:
374600882
ADMINISTRATOR:FLOR DE LYS BARAWIDFACILITY TYPE:
735
ADDRESS:750 VINE STREETTELEPHONE:
(760) 489-7750
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:6CENSUS: 6DATE:
11/19/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Caregiver Ervin MolinaTIME COMPLETED:
12:45 PM
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Licensing Program Manager (LPM) John Rante and Licensing Program Analyst (LPA) Kayla Hilario, conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPM and LPA met with Caregiver Cristina Juanico, and we discussed the purpose of the visit. All staff present have a current criminal record clearance. Caregiver Ervin Molina arrived during the visit.

LPM and LPA conducted a tour of the facility, both inside and outside and observed the clients in care. In accordance with the Department’s Infection Control, LPM and LPA provided technical assistance, evaluated, and observed the facility's implementation of their mitigation plan to include disinfection, testing surveillance, and screening protocols as well as the use of personal protective equipment.

No deficiencies were cited or observed on this date.

The Licensee will be provided a copy of their appeal rights (LIC9058 01/16). An exit interview was conducted with the Caregiver Ervin Molina and a copy of this report will be emailed to the Licensee with an electronic read receipt as confirmation of documents.
SUPERVISOR'S NAME: Icela EstradaTELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
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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