374602731-8-15-2024-08-AS-MGCO-D872HA-20240815172424

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374602731
Report Date: 08/15/2024
Date Signed: 08/15/2024 05:25:17 PM

Document Has Been Signed on 08/15/2024 05:25 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	YAWIPI ARF		FACILITY NUMBER:	374602731
ADMINISTRATOR/ DIRECTOR:	BRAVO, MARTHA CARO		FACILITY TYPE:	735
ADDRESS:	3827 WILD OATS LANE		TELEPHONE:	(619) 399-5875
CITY:	BONITA	STATE: CA	ZIP CODE:	91902
CAPACITY: 4		CENSUS: 3	DATE:	08/15/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Administrator, Martha Caro		TIME VISIT/ INSPECTION COMPLETED:	01:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analysts (LPA) Marisela Garcia-Centeno conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by Caregiver, Casandra Garcia. LPA identified herself to, and discussed the purpose of the visit with Administrator, Martha Caro. Staff present had current criminal record clearances. Administrator certificate is current. According to the facility’s license, the facility has a maximum capacity of four (4) clients, of which all can be non-ambulatory. During today’s inspection there were three (3) clients in care, per physician’s report all clients are non-ambulatory. All clients were out in the community during the visit. LPA, accompanied by Administrator, Caro, toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Clients’ bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was compliant at 75 F. Hot water temperature at taps accessible to clients was compliant: Kitchen sink was 112 F. There were at least 2 days of perishable food, and at least 7 days of non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas. Facility has a swimming pool in the backyard that is gated and locked. Per licensee, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. (continue at LIC812C)

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
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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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: YAWIPI ARF	FACILITY NUMBER: 374602731
	VISIT DATE: 08/15/2024

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(Continue from LIC812)

First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA interviewed staff and reviewed multiple staff and client records/files. Clients were off site at day program during inspection. The files which LPA reviewed contained required documents. Confidential records were stored in locked area. Liability insurance was current until April 12, 2025 and Surety Bond effective until 1/24/2028. All staff had current first aid certificates through August 8, 2026. Staff completed annual training as required per title 22 regulation.

No deficiencies were cited during today's annual inspection.

An exit interview was conducted with Caro to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
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

LIC809 (FAS) - (06/04)

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