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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602601
Report Date: 02/21/2024
Date Signed: 02/21/2024 04:46:25 PM

Document Has Been Signed on 02/21/2024 04:46 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: 3DATE:
02/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Caregiver Benjamin MacaspacTIME COMPLETED:
04:50 PM
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Benjamin Macaspac. House Manager Ramil Macaspac arrived during the visit.

The facility is licensed for a maximum capacity of 4 clients, 1 of which may be non-ambulatory. During today’s visit, the facility had a census of 3 clients, 2 of which were non-ambulatory, Client 1 and Client 2 (C1 and C2). [House Manager was provided with an LIC811 Confidential Names List to identify both clients.] Both non-ambulatory clients were residing in rooms designated as ambulatory by the facility fire clearance. LPA spoke with House Manager Ramil Macaspac regarding the ambulatory status of clients. LPA did not observe any aspects of delayed egress or secured perimeter. The Administrator for the facility is Hector Obar and their certificate was valid and current.

During today’s visit, LPA toured the facility and inspected each room of the facility, including client rooms, bathrooms for client and staff use, kitchen, garage, common areas, and outside space. No bodies of water were observed near or on the premises. According to Ramil Macaspac, no firearms or weapons are stored on the premises. The facility was found to be clean, safe, and in good repair with no pathway obstructions. The facility’s water temperature was measured at 119.5 degrees Fahrenheit in a common bathroom for client use. The facility’s internal temperature was measured at 70 degrees Fahrenheit. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. LPA also observed locked storage for client medications and client and staff files. Client medications are stored in their original container and label. LPA observed a 2-day supply of perishable food and a 7-day supply of non-perishable food present at the facility. The facility refrigerator was kept at 40 degrees Fahrenheit, and the facility freezer was kept at 0 degrees Fahrenheit.

Continued on LIC809-C page...
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2024
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: 02/21/2024
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LPA observed linens and hygiene products provided to the clients that are in good repair and sufficient to meet their needs. Staff present at the facility during the time of the inspection had a criminal background clearance, were associated to the facility, and had a first aid certificate.

LPA reviewed multiple client and staff records. Each client record was complete and contained a signed admission agreement, updated physician’s report and medical assessment, documents regarding safeguarding personal property and cash resources, and personal rights. LPA reviewed clients’ personal and incidental money and ledger with the House Manager and did not discover any inconsistencies. Each staff file was complete and contained a personnel record, first aid certificate, fingerprint clearance and association, and a health screening. LPA spoke with staff and clients present at the facility during the time of the inspection and those interviews did not reveal any licensing or regulatory concerns.

The House Manager will submit copies of the LIC500 Personnel Report and LIC610D Disaster Plan to the Department within 15 business days.

The follow deficiency for exceeding non-ambulatory capacity is cited per California Code of Regulations Title 22 and noted on the attached LIC809-D page. In addition, civil penalties are being assessed for exceeding non-ambulatory capacity and are noted on the attached LIC421IM in the amount of $500.

An exit interview was conducted with House Manager Ramil Macaspac, whose signature below confirms receipt of a copy of this report (LIC809), the LIC811, the LIC421IM, and the Licensee Appeal Rights (LIC9058 3/22).
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/05/2024 04:26 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 03/05/2024 03:54 PM


Created By: Rebecca A Ruiz On 02/21/2024 at 04:12 PM
Link to Parent Document Below:
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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80010(b)
Limitations on Capacity and Ambulatory Status
(b) Facilities or rooms approved for ambulatory clients only shall not be used by nonambulatory clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation and record review, the licensee did not comply with the section cited above in that 2 of 3 clients, C1 and C2 are non-ambulatory and are residing in rooms designated as ambulatory by the fire clearance which poses an immediate safety risk to persons in care.
POC Due Date: 02/22/2024
Plan of Correction
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House Manager will submit an LIC200 Application requesting additional non-ambulatory clients to the Department by the POC due date of 2/22/2024.
This is an amended version of the original report dated 2/21/2024.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lizzette Tellez
LICENSING EVALUATOR NAME:Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:
DATE: 02/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/21/2024


LIC809 (FAS) - (06/04)
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