374602601-5-19-2023-08-AS-ARAZ-CRYR5A-20230519124248

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374602601
Report Date: 05/19/2023
Date Signed: 05/19/2023 12:42:53 PM

Document Has Been Signed on 05/19/2023 12:42 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
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	SORRENTO ARF CORP.		FACILITY NUMBER:	374602601
ADMINISTRATOR:	OBAR, HECTOR		FACILITY TYPE:	735
ADDRESS:	5072 CORTE ALACANTE		TELEPHONE:	(760) 721-3890
CITY:	OCEANSIDE	STATE: CA	ZIP CODE:	92057
CAPACITY: 4		CENSUS: 4	DATE:	05/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	House Manager Ruben Yamuto		TIME COMPLETED:	01:00 PM

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Licensing Program Analyst (LPA) conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with house manager Ruben Yamuta.

According to the facility’s license, the facility has a maximum capacity of four (4) clients, of whom one (1) may be non-ambulatory. During today’s inspection, there were a total of four (4) clients in care. Per physician’s reports, two (2) clients are ambulatory and (2) are non-ambulatory. Per Yamuta, one non-ambulatory client is currently at Kindred Hospital and has been there since since February 2023. Yamuta stated that the client may be permanently moved to a skilled nursing facility. LPA spoke to Yamuta about being out of compliance if client is to return to the facility without changing non-ambulatory allowance. LPA also spoke to administrator Hector Obar via telephone and explained the situation. Obar was advised that he should apply for more non-ambulatory spots at the facility if he intends to have more than one (1) non-ambulatory clients at the facility. Obar stated this would be done and LPA provided him with duty officer phone number.

LPA, accompanied by house manager Yamuta, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. Hot water temperature at taps accessible to clients were all compliant: Kitchen sink was 120 F, bathroom #1 sink was 119 F and bathroom #2 sink was 119 F.

[CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Alyssa Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023

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
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SORRENTO ARF CORP.	FACILITY NUMBER: 374602601
	VISIT DATE: 05/19/2023

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[CONTINUED FROM LIC 809]

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas.

No pools or bodies of water on the premises. Per house manager, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA interviewed staff and clients and reviewed multiple staff and client records/files. LPA interviews did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in locked areas.

No deficiencies were observed or cited during today's annual inspection.

An exit interview was conducted with Yamuta to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Alyssa Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023

LIC809 (FAS) - (06/04)

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