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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602441
Report Date: 12/05/2023
Date Signed: 01/08/2024 07:54:34 AM

Document Has Been Signed on 01/08/2024 07:54 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:SAM & ROSE STEIN EDUCATION CENTERFACILITY NUMBER:
374602441
ADMINISTRATOR:PONCE, SERGIOFACILITY TYPE:
775
ADDRESS:4990 WILLIAMS AVETELEPHONE:
(619) 463-3300
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY: 45CENSUS: 38DATE:
12/05/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Program Supervisor Melinda Williams.TIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Required Annual Inspection to ensure substantial compliance with Title 22 regulations. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Program Supervisor Melinda Williams. Later, Administrator Joanne Garcia joined the tour.

According to the facility’s license, there may be a maximum of forty-five (45) developmentally disabled adults ages 18 and above; of which five (5) may be non-ambulatory. The facility does not feature a secured perimeter or delayed egress doors.

LPA accompanied by Program Supervisor Williams, toured the interior and exterior of the day program facility. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. There are two (2) working bathrooms in the facility. Doors, sinks, and toilets were in working order. LPA observed a surplus of incontinence supplies for daily as well as emergency use. LPA observed an area that is available for privacy such as rest, phone calls and de-escalation.

Hand hygiene supplies and Personal Protective Equipment were present. The facility does not prepare food on the premises and clients bring their own lunches. Snacks are available as needed. The facility had sufficient space and equipment to facilitate meetings and client activities. The facility’s ambient internal temperature was comfortable and compliant with Regulations. Hot water temperature at taps accessible to clients were also compliant.

[CONTINUED ON LIC809-C]

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SAM & ROSE STEIN EDUCATION CENTER
FACILITY NUMBER: 374602441
VISIT DATE: 12/05/2023
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[CONTINUED FROM LIC809]

There were no sharp objects or toxic chemicals/poisons accessible to clients. No pools or bodies of water were observed on the premises. All fire and carbon monoxide detectors are working. Emergency lighting, and facility telephone were all working. Fire extinguishers were operable. First aid kits were complete and readily accessible.

LPA interviewed multiple staff and clients. LPA’s interviews did not raise any licensing concerns. LPA also reviewed multiple staff and client records/files. Files reviewed contained required documents. Confidential records were stored in locked areas. Required licensing postings were observed in visible areas of the facility. LPA’s observed participants were being treated with dignity by staff, and there were sufficient staff on duty to meet clients’ needs.

Based on today's inspection there are no deficiencies observed at this time in the areas evaluated. An exit interview was conducted, this report was discussed with Program Supervisor Williams, along with a copy of the Licensee/Appeal Rights (LIC 9058 01/2106), and their signature on this form acknowledges receipt and a copy of the report was given to Program Supervisor Williams.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023
LIC809 (FAS) - (06/04)
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