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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602601
Report Date: 02/23/2022
Date Signed: 02/23/2022 09:30:53 PM

Document Has Been Signed on 02/23/2022 09:30 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:SORRENTO ARF CORP.FACILITY NUMBER:
374602601
ADMINISTRATOR:OBAR, HECTORFACILITY TYPE:
735
ADDRESS:5072 CORTE ALACANTETELEPHONE:
(760) 721-3890
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY: 4CENSUS: 4DATE:
02/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:50 PM
MET WITH:Benjamin Macaspac, CaregiverTIME COMPLETED:
04:50 PM
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Licensing Program Analyst,(LPA) Kristina Ryan, conducted an unannounced annual required licensing inspection. LPA was granted entry by and met with Caregiver, Benjamin Macaspac. LPA was granted entry after identifying herself 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 statutes, regulations and other written requirements that are most relevant to protecting the health of residents in care and staff, including in the area of infection control practices.

LPA reviewed the facility’s Plan for Epidemic Outbreak Specific to COVID-19 Mitigation Plan Report (LIC 808) with Mr. Macaspac including the following sections: Person in Care, Staff, Visitors, Facilities without COVID-19, Residents, Facility has plans for infection control and physical distancing. 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 observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff, residents and visitors; a sign-in policy enacted for all visitors; signs will be 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 encouraged for residents; hand washing stations readily available, an indoor visitation area; emergency agencies’ contact information posted in a location visible to staff and residents; and an adequate supply of PPE. The facility was provided consultation to be in compliance with and implement infection control practices as outlined in its LIC 808.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Kristina Ryan
LICENSING EVALUATOR SIGNATURE: DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/23/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SORRENTO ARF CORP.
FACILITY NUMBER: 374602601
VISIT DATE: 02/23/2022
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Based on today’s inspection, no deficiencies were cited. An exit interview was conducted with Mr. Macaspac. A copy of this report, along with the Licensee Rights (9058 01/16) was emailed to the administrator at the conclusion of the visit, an electronic response confirms the receipt of these documents.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Kristina Ryan
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
LIC809 (FAS) - (06/04)
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