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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602842
Report Date: 03/06/2024
Date Signed: 03/06/2024 04:35:42 PM

Document Has Been Signed on 03/06/2024 04:35 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:ARC SULPIZIO FAMILY ARC CENTERFACILITY NUMBER:
374602842
ADMINISTRATOR:MELANIE MCCOYFACILITY TYPE:
775
ADDRESS:3030 MARKET STREETTELEPHONE:
(619) 685-1175
CITY:SAN DIEGOSTATE: CAZIP CODE:
92102
CAPACITY: 225CENSUS: 94DATE:
03/06/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Rainer Milton, Program AdministratorTIME COMPLETED:
04:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required annual inspection and in conjunction conducted this case management visit at the day program. LPA Lopez identified herself and was granted entry receptionist Minerva Jimenez. LPA stated the purpose of the visit and reviewed the basic elements of the visit with Program Administrator Rainer Milton and Director of Adult Day Services Terri Medley.

On March 6, 2024, a self reported incident transpired during the programs required annual inspection, for Client #1 (C1 – see LIC811 Confidential Names List). C1 reported to program staff #1 (S1) an incident that involved their driver but did not elaborate about the incidents. The driver is not a staff person for the day program and the program is in the process of gathering additional information. All proper notifications were made, and reports are pending. An incident report will be forthcoming to the San Diego Regional Office (SDRO).

LPA Lopez advised Program Administrator Rainer Miton that at this time the case management visit requires further review and requested additional information to be submitted to LPA once available. Follow-up telephone calls or visits are necessary before a determination is made.

During today's visit, LPA toured the facility, spoke with staff, and requested and obtained copies of client records maintained by the facility. No deficiencies were cited during this case management visit.

An exit interview was conducted with Program Administrator Milton to whom a copy of this report, and Licensee/Appeal Rights (LIC 9058 3/22) were provided at the conclusion of the visit. The signature below confirms the documents were received.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2024
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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