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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602644
Report Date: 04/24/2024
Date Signed: 04/24/2024 11:47:55 AM

Document Has Been Signed on 04/24/2024 11:47 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:CATSPAW PLACEFACILITY NUMBER:
374602644
ADMINISTRATOR/
DIRECTOR:		CUARESMA, MELANIEFACILITY TYPE:
735
ADDRESS:1154 CATSPAW PLACETELEPHONE:
(760) 658-6438
CITY:ESCONDIDOSTATE: CAZIP CODE:
92029
CAPACITY: 6CENSUS: 5DATE:
04/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:56 AM
MET WITH:Julita Ramirez, Administrator Assistant TIME VISIT/
INSPECTION COMPLETED:
11:45 AM
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On 4/5/24 (LPA) Javina George made an attempted visit, for the purpose of conducting the facilities 1 year required visit. There was no one at the home at the time of the attempt, and the inspection could not be conducted. On today's date 4/24/24 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility and was able to conduct the facility's 1 year required visit. LPA was greeted and granted entry by Assistant Administrator Julita Ramirez, where LPA explained the purpose of the visit. At the time of the visit there were zero (0) resident's present as they were all at the day program. All staff present were observed to have obtained criminal record clearance and were associated to the facility.

LPA conducted a tour of interior and exterior of the facility. The facility is a single story home consisting of five (5) bedrooms and three (3) bathrooms. LPA observed for there to be construction workers on the premises. The facility is currently undergoing renovations room by room. The renovations include upgrading the bathrooms, painting, replacing closet doors and repairs of chips and discoloration. The renovations are expected to be completed within the next six (6) months.

The facility was observed to have one fully charged fire extinguisher. The smoke and carbon monoxide detectors were tested and were observed to be operable. The emergency disaster drills are conducted on a quarterly basis and the last drill was conducted on 4/1/24. The medications are locked in cabinet located in the hallway. The chemicals and sharp objects are locked in the cabinet underneath the kitchen sink. There are no pools or bodies of water observed on grounds. There are no known guns or ammunition on the premises. The hot water was tested and was found to be within regulatory limits measuring 109.7-111.2 degrees F.

LPA conducted a review of both staff and resident files. The resident files had the required documentation such as admission agreements, Individual Program Plan (IPP), or appraisal needs and services plan, and medical assessment. P&I funds were reviewed for 2 of 5 residents and all money was present and accounted for.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: CATSPAW PLACE
FACILITY NUMBER: 374602644
VISIT DATE: 04/24/2024
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Staff files were observed to have the required training, criminal record clearance, personnel record and valid Cardio Pulmonary Resuscitation (CPR) certification. The administrator certificate expires on 2/4/25.

The facility was observed to have the required postings, and a copy of current liability insurance was obtained and will be filed in the facility main file at the Regional office. Based on today's inspection no deficiencies were observed.

An exit interview was conducted and a copy of this report was provided to Assistant Administrator Julita Ramirez.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024
LIC809 (FAS) - (06/04)
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