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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602117
Report Date: 03/10/2022
Date Signed: 03/11/2022 09:47:57 AM


Document Has Been Signed on 03/11/2022 09:47 AM - 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:TOMAS RESIDENTIAL CAREFACILITY NUMBER:
374602117
ADMINISTRATOR:NORMA TOMASFACILITY TYPE:
740
ADDRESS:6344 JOUGLARD STTELEPHONE:
(619) 434-5235
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY:6CENSUS: 3DATE:
03/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:04 AM
MET WITH:Licensee, Abraham Tomas, and Administrator, Norma TomasTIME COMPLETED:
12:20 PM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Required 1 - Year Visit. LPA was greeted by Administrator, Norma Tomas, identified himself, and discussed the purpose of the visit. Licensee, Abraham Tomas, arrived during the visit, and conducted a tour of the facility with the LPA.

In accordance with the Department’s Infection Control program, the LPA provided technical assistance and observed and evaluated the facility's implementation of their COVID-19 Mitigation Plan (LIC 808).

LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff and visitors; a sign-in policy enacted for all 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; hand sanitizer/hand washing stations readily available; a designated visitation area; and the emergency agencies’ contact information posted in a location visible to staff and residents. Based on observations, the facility is in compliance with and has implemented infection control practices as outlined in its LIC 808. No deficiencies were observed during today's visit.

An exit interview was conducted with Licensee, Abraham Tomas, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided via electronic mail. An electronic mail read receipt confirms these documents were received by the Licensee, Abraham Tomas.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/10/2022
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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