<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600980
Report Date: 09/29/2021
Date Signed: 09/29/2021 03:36:39 PM

Document Has Been Signed on 09/29/2021 03:36 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:CASA DE CASTRO IIFACILITY NUMBER:
374600980
ADMINISTRATOR:CHERYL CASTROFACILITY TYPE:
740
ADDRESS:7766 PRAIRIE MOUND WAYTELEPHONE:
(619) 857-6945
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY: 6CENSUS: 6DATE:
09/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Licensee, Cheryl CastroTIME COMPLETED:
02:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA), Alexandre Vo, conducted an unannounced annual required licensing inspection. LPA was granted entry by Licensee, Cheryl Castro, after identifying himself and disclosing the purpose of the visit. An overall tour of the facility was conducted inside and out. The inspection included, but was not limited to, verifying compliance with infection control practices.

The tour was conducted with the Licensee. LPA reviewed the facility’s Plan for Epidemic Outbreak Specific to COVID-19 Infection Control, including the following sections: Persons in Care, Staff, Visitors, Facilities without COVID-19, Residents, Facility's Plans for Infection Control and Physical Distancing, and Memory Care. LPA assessed the strategies that the facility is employing for the prevention, containment and mitigation of COVID-19, implementation of infection control guidance, staff retention and essential health and safety.

LPA reviewed items pertaining to central entry points for universal entry screening; routine symptom screening initiated for staff, residents and visitors; signs posted at facility entrance with the facility’s visitor policy and signs throughout the facility to promote hand hygiene, cough/sneeze etiquette and physical distancing; face coverings worn by staff and clients; hand sanitizer/hand washing stations readily available; a designated visitation area; emergency agencies’ contact information posted in a location visible to staff and clients; and an adequate supply of PPE.

No deficiencies were cited during this visit. Technical assistance (TA) was provided regarding documenting routine/daily symptom screening, hand sanitation signs, updated visitation policy and sign-in along with contact information and vaccine verification, and N-95 fit-testing per PIN 21-10-ASC. TA's are listed on the accompanying 9102.

An exit interview was conducted with the Licensed. A copy of this report, along with the Licensee Rights (9058 01/16) were provided to the Licensee via e-mail. A confirmation e-mail was requested.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Alexandre Vo
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 8