374602610-9-22-2023-08-AS-RGAZ-CVWNXE-20230922105102

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374602610
Report Date: 09/22/2023
Date Signed: 09/22/2023 10:51:06 AM

Document Has Been Signed on 09/22/2023 10:51 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	INNOVATIVE CENTER		FACILITY NUMBER:	374602610
ADMINISTRATOR:	RONALD FABIAN		FACILITY TYPE:	775
ADDRESS:	7464 UNIVERSITY AVENUE		TELEPHONE:	(619) 461-0914
CITY:	LA MESA	STATE: CA	ZIP CODE:	91941
CAPACITY: 60		CENSUS: 52	DATE:	09/22/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Domingo Cuison		TIME COMPLETED:	10:55 AM

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Licensing Program Analyst (LPA) Riza Alvarez conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by Cynthia Sison, Administrative Assistant with whom LPA discussed the purpose of the visit. Program Director Domingo Cuison arrived at the facility during the inspection.

According to the facility’s license, there may be a maximum of sixty (60) developmentally disabled adults, all of whom may be non-ambulatory. During today’s inspection, there were forty-five (45) clients present at the day program site. The facility does not feature a secured perimeter or delayed egress doors.

LPA, accompanied by Mr. Cuison, toured the interior and exterior of the day program facility. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Doors, windows and screens, sinks, and toilets were in working order. Hand hygiene supplies and Personal Protective Equipment were present. The facility had sufficient space and equipment to facilitate meetings and client activities. The facility’s ambient internal temperature was comfortable and compliant with Regulations. Hot water temperature at taps accessible to clients were also compliant.

There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. No pools or bodies of water were observed on the premises. Per Program Director, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguishers (4) were serviced within the last 12 months. First aid kit was complete and readily accessible.

[CONTINUED ON LIC809-C]

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Riza Gloria Alvarez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023

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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: INNOVATIVE CENTER	FACILITY NUMBER: 374602610
	VISIT DATE: 09/22/2023

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[CONTINUED FROM LIC809]

LPA interviewed multiple staff and clients. LPA interviews did not raise any licensing concerns. LPA also reviewed multiple staff and client records/files. Files reviewed contained required documents. Confidential records were stored in locked areas. Required licensing postings were observed in visible areas of the facility.

No deficiencies were observed or cited during today's visit.

An exit interview was conducted with Program Director Cuison, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Riza Gloria Alvarez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2023

LIC809 (FAS) - (06/04)

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