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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602608
Report Date: 11/01/2024
Date Signed: 11/01/2024 01:32:16 PM

Document Has Been Signed on 11/01/2024 01:32 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:SAILS ALEXANDERFACILITY NUMBER:
374602608
ADMINISTRATOR/
DIRECTOR:		MARIBEL ROBLEDOFACILITY TYPE:
735
ADDRESS:301 JOHAH RDTELEPHONE:
(760) 371-2214
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY: 4CENSUS: 4DATE:
11/01/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:08 PM
MET WITH:LEAD CAREGIVER, ALICIA HIPOLITOTIME VISIT/
INSPECTION COMPLETED:
01:48 PM
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On November 01, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the required annual inspection. LPA Mixson met Lead Caregiver Alicia Hipolito.

LPA Mixson toured the facility and inspected the inside and outside of the facility. The facility is a single-story home located at 301 Jonah Rd Escondido, Ca. 92027. The facility phone number is (760) 371-2214, and it is operable. Currently there is one caregiver was present and one caregiver took the four residents to the day program.

Physical Plant: The physical plant is clean, neat, and orderly. Outdoor and indoor passageways are free of obstruction at the time of the inspection. The facility has four bedrooms, and each bedroom has the required furniture, storage space, and sufficient lighting. All Bedrooms rooms were equipped with the required items as per Title 22 regulations. The three bathrooms were neat and clean all utilities were operable, and the hot water temperature was tested and was within regulations. The restrooms were equipped with liquid soap and paper towels. The LPA toured the kitchen, living room and the TV: room.

The kitchen area was clean, organized, and free or odors. All food requirements were met, the seven-day supply of non-perishable, and the two-day supply of perishable. The LPA inspected the common areas, and the laundry room. Smoke detectors were in the green and operable. The fire extinguisher was in the green, and last reviewed for services in 2024. Carbon monoxide alarms, along with smoke detectors were observed, and were operable.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

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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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SAILS ALEXANDER
FACILITY NUMBER: 374602608
VISIT DATE: 11/01/2024
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Care & Supervision/Administration: Adequate staff are present for the supervision of resident in care. Floor plans, telephone numbers and personal rights were found posted in the facility.

Records Reviewed and Resident Files: two resident files were reviewed and possessed all required paperwork.



MEDICATION: Medications were reviewed for one resident in care. Medications were labeled and maintained in compliance with label instructions and State and Federal law. Medications were observed to be safe, locked, and inaccessible to residents in care. Medications and medication documentation was observed to be well organized and monitored.

Disaster preparedness: LPA Mixson reviewed the facility's emergency and disaster plan as well as disaster training binder. LPA observed the last fire drill met the department standards and was conducted on 10/01/2024.

Infection Control: LPA Mixson observed the hand washing stations in the facility restrooms. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan and found all required infection control measures.



Emergency disaster plans, personal rights, and complaint procedures were posted in a prominent area. There was adequate seating in the common areas and sufficient space for activities. The monthly activity calendar, two staff files, four resident files, were reviewed. One interview with lead caregiver here in the facility was conducted.

There were no regulation violations observed during today’s visit.

An exit interview was conducted, and a copy of this report was provided to Lead Caregiver, Alicia Hipolito.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024
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Document Has Been Signed on 11/01/2024 01:32 PM - It Cannot Be Edited


Created By: Venus Mixson On 11/01/2024 at 01:23 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
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SAILS ALEXANDER
FACILITY NUMBER: 374602608

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/01/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
85065.6(b)(1)
Night Supervision
(b) Employees providing night supervision from 10:00 p.m. to 7:00 a.m., as specified in (c) through (f) below, shall be available to assist in the care and supervision of clients in the event of an emergency, and shall have received training in the following: (1) The facility's planned emergency procedures.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interviews and record reviews the licensee did not comply with the section cited above in 01 out of 01 night staff were not training in the which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 11/08/2024
Plan of Correction
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Facility staff that work at night will received training in emergency procedures by the listed date of correction.
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:Jazmond D Harris
LICENSING EVALUATOR NAME:Venus Mixson
LICENSING EVALUATOR SIGNATURE:
DATE: 11/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/01/2024


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