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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602644
Report Date: 04/30/2023
Date Signed: 04/30/2023 03:30:05 PM

Document Has Been Signed on 04/30/2023 03:30 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:CATSPAW PLACEFACILITY NUMBER:
374602644
ADMINISTRATOR:CUARESMA, MELANIEFACILITY TYPE:
735
ADDRESS:1154 CATSPAW PLACETELEPHONE:
(760) 658-6438
CITY:ESCONDIDOSTATE: CAZIP CODE:
92029
CAPACITY: 6CENSUS: 6DATE:
04/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:ADMINISTRATOR, MELANIE CUARESMATIME COMPLETED:
03:38 PM
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On April 30, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived to the facility unannounced in order to conduct the required annual inspection. LPA Mixson met with Administrator, introduced self, and stated the purpose of the visit. LPA Mixson toured the facility, along with the Administrator, and inspected the inside and outside of the facility. The facility is a single story home, and currently there six residents, four staff. The facility has four bedrooms and three full baths. There is a kitchen, dining room, and living room. Additionally, the facility has a two car garage and a back yard.
Physical Plant: The physical plant, is in good condition, neat, and orderly. The lawns and shrubbery are well maintained. Outdoor and indoor passageways are free of obstruction at the time of this visit. Residents bedrooms have the required bedding and furniture; such as clean mattresses, night stands, storage space, and sufficient lighting. The bedroom temperatures were comfortable. All resident bedrooms were equipped with the required items. The Administrator tests the hot water temperature weekly and it tested within the required regulation. The restrooms were equipped with non-skid surfaces. LPA Mixson toured the kitchen and dining area. The facility had a menu posted and available for review. Kitchenware was in good condition and stored safely. Emergency food and water are available. LPA Mixson inspected the common areas. Smoke detectors are hard wired and are tested quarterly. The fire extinguisher was in the green and last checked 02/09/2023, and is operable. Carbon monoxide alarms, along with smoke detectors were observed, and showed a green light. Fireplace has screen, is covered, and is clean. There was a locked and centralized storage area for medications. Medications are ordered through a pharmacy that utilizes bubble packs. The facility had a designated area for resident and staff files, and it was lockable. 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. LPA Mixson observed a monthly activity calendar. LPA Mixson reviewed three staff files, five resident files, and conducted three staff interviews with the Administrator and Licensee, and one staff. Additionally, LPA Mixson conducted three resident interviews. There were no regulation violations observed during todays visit.
An exit interview was conducted and a copy of this report, along with the LIC 811, was provided to Administrator.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 04/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/30/2023
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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