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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602093
Report Date: 10/21/2021
Date Signed: 10/21/2021 04:29:11 PM

Document Has Been Signed on 10/21/2021 04:29 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:ALTA IIFACILITY NUMBER:
374602093
ADMINISTRATOR:CHRISTINA GRUBBSFACILITY TYPE:
735
ADDRESS:1337 ALTA VISTA DRIVETELEPHONE:
(760) 941-0919
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY: 6CENSUS: 6DATE:
10/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Christina Grubbs, AdministratorTIME COMPLETED:
10:55 AM
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Licensing Program Analyst (LPA) Carmen Lopez made an unannounced visit to the facility to conduct an annual required licensing inspection. LPA identified herself and was granted entry by Christina Grubbs, Administrator. LPA met with Administrator Grubbs and discussed the purpose of today’s visit.

A tour of the facility was conducted inside and out. LPA, accompanied by the Administrator conducted a general overall inspection, with specific focus on infection control protocols.

During today's inspection LPA observations include the following: Symptom screening procedures/ for staff, residents and visitors; posted signs regarding visitor policy, promoting hand washing, cough and sneeze etiquette and other infection control procedures; testing plan and procedures; plans for containing infections, PPE supplies procedures and training; and disinfection procedures.

Based on today’s inspection, no deficiencies were observed. An exit interview was conducted with Administrator Grubbs. A copy of this report, along with the Licensee Rights (01/2016) was emailed to Christina Grubbs, Administrator, at the conclusion of the visit. LPA requested for the Administrator to send LPA an electronic message reply confirming receipt of these documents.

LPA requested Administrator Grubbs to submit a Personnel Report LIC 500 and Emergency Disaster Plan LIC 610-D to the licensing office within 10 business days. The facility had a current Designation of Administrative Responsibility LIC 308 on file. Forms are available at www.ccld.ca.gov.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2021
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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