<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602843
Report Date: 09/24/2021
Date Signed: 09/28/2021 10:31:24 AM

Document Has Been Signed on 09/28/2021 10:31 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:EASTER SEALS SOUTHERN CALIFORNIA ESCONDIDOFACILITY NUMBER:
374602843
ADMINISTRATOR:FINE, JEFFREYFACILITY TYPE:
775
ADDRESS:401 S IVY STTELEPHONE:
(760) 737-3990
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY: 23CENSUS: 23DATE:
09/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:04 PM
MET WITH:Program Coordinator, Alicia Rivas TIME COMPLETED:
04:40 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 Analyst (LPA) Debbie Correia conducted an unannounced annual inspection on September 24, 2021. LPA met with Program Coordinator (PC) Alicia Rivas, identified herself and explained the purpose of the visit. LPA also identified herself to the Interim Program Director Joanna Duncan who joined a portion of the inspection via teleconference.

LPA Correia, accompanied by PC Rivas, conducted a tour of the facility. During the visit there were no clients present at the facility. Services are being provided virtually and in-person but off-site the facility. Clients (no more that 1 or 2 at a time), come to the facility on occasion (implementing 6 ft social distancing) to utilize equipment, such as the printer, when needed. LPA observed universal entrance and COVID-19 screening protocols In accordance with the Department’s Infection Control guidance, LPA provided technical assistance, evaluated, and observed the facility's implementation of their mitigation plan to include disinfection, testing surveillance, supply of personal protective equipment (PPE), also the implementation of screening protocols prior to meeting the client off-site to provide service provision. The procedures include verifying compliance with statutes, regulations and other written requirements that are most relevant to protecting the health of residents in care and staff, including in the area of infection control practices.

Based on today's visit, there were no deficiencies observed at this time. An exit interview was conducted, Licensee's Rights (LIC 9058 01/16) along with a copy of this report was provided, via email, to Program Director Rivas, and Interim Director Duncan. An electronic read reply confirms receipt of the reports.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2021
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 1