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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602602
Report Date: 08/15/2024
Date Signed: 08/15/2024 12:59:12 PM

Document Has Been Signed on 08/15/2024 12:59 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:HEARTS OF GOLD CARE HOMES, INC.FACILITY NUMBER:
374602602
ADMINISTRATOR/
DIRECTOR:
CHRISTINA GRUBBSFACILITY TYPE:
735
ADDRESS:405 AVALON DRIVETELEPHONE:
(760) 842-5575
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY: 4CENSUS: 4DATE:
08/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:50 AM
MET WITH:ADMINISTRATOR, CYNTHIA MEYERTIME VISIT/
INSPECTION COMPLETED:
01:08 PM
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On August 15, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the Required Annual Inspection and met with Administrator, Cynthia Meyer. The facility file review was conducted at the Regional Office and additional records were requested and reviewed on site. The facility is licensed for four Adult Residents and is currently operating at "Full Capacity" of (4), Adults (735), facility type.

LPA Mixson toured the facility along with Administrator, Brenda Cruz, and made observations pertaining to the annual visit. LPA inspected the facility inside and outside there were no obstructions or debris to the indoor or outdoor passageways at the time of this visit. The facility is a single-story home located at 405 Avalon Drive Vista, CA. 92084.

Physical Plant: The facility phone number is (760)842-5575 and it is operable. LPA Mixson observed the residents’ bedrooms, and each was equipped with required furniture as per Title 22. LPA Mixson inspected facility bathrooms, and the hot water temperature tested within regulations. The bathrooms were clean, and appliances were operating appropriately currently at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers. LPA Mixson observed required postings such as "If you See Something, Say Something" and the "Personal Rights." The cleaning supplies and sharp items were kept locked and inaccessible to the residents in care. There was a designated storage space for the residents and staff files, and it was locked and inaccessible to residents in care currently at the time of this visit.

Medications: Were locked and inaccessible to residents in care, and there was a sufficient supply of medication for each resident. The overall facility is clean, the furniture is in good condition. The facility cooling system and other appliances were operable currently at the time of this visit.

Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils were in sufficient supply and stored properly, and sharp items are locked.

Care & Supervision: Facility has sufficient staff on site currently all Residents are at the day program.

Records Review: LPA Mixson reviewed resident and staff files, conducted two staff interviews. There were no Title 22, Division 6 Regulation violations observed or cited during today’s visit.

An exit interview was conducted, and a copy of this report was discussed and given to Administrator, Cynthia Meyer.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
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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