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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600926
Report Date: 04/13/2022
Date Signed: 04/13/2022 06:12:34 PM


Document Has Been Signed on 04/13/2022 06:12 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:DITA RESIDENTIAL CARE FACILITYFACILITY NUMBER:
374600926
ADMINISTRATOR:BERNADITA R. CABRERAFACILITY TYPE:
740
ADDRESS:303 DALEGROVE LANETELEPHONE:
(619) 267-8270
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY:6CENSUS: 3DATE:
04/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:13 PM
MET WITH:Bernardita Cabrera, LicenseeTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Dawn Segura visited the facility to conduct an annual required licensing inspection. LPA introduced herself and was granted entry into the facility by Bernardita Cabrera, Licensee, to whom she disclosed the purpose of the visit.

During today's visit, LPA toured the facility and verified compliance with infection control practices. LPA observed one central entry point for universal entry screening; symptom screening initiated at entry for staff, residents, and visitors; a sign-in policy enacted for visitors; signs in the facility to promote hand hygiene, hand sanitizer/hand washing station readily available; face covering worn by staff; available visitation area; emergency agencies’ contact information visible to staff; and a supply of cleaning products and PPE. Signs promoting cough/sneeze etiquette, symptom and transmission awareness were temporarily removed while painting is being done in the facility.

No deficiencies were cited during today’s visit. An exit interview was conducted with Bernardita Cabrera, and a copy of this report and Licensee Rights (LIC 9058 FAS 01/16) will be provided, via email, following the visit. An electronic receipt of confirmation was requested to be sent to LPA upon receipt of the documents.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:
DATE: 04/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/13/2022
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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