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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602843
Report Date: 09/29/2023
Date Signed: 09/29/2023 11:36:15 AM

Document Has Been Signed on 09/29/2023 11:36 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 AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
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: 22DATE:
09/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Alicia Rivas, Program CoordinatorTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA), Jacqueline Shaw Ross conducted an unannounced annual required visit. LPA met with Program Coordinator, Alicia Rivas and was granted entry. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with California Code of Regulations, Title 22, Division 6. The facility is a community-based program and is approved for twenty three (23) development disabled adults; ages 18 and above.

Tour included:
Physical Plant: front entrance, interior and surrounding exterior were in good repair with no pathway obstruction. The facility was clean and odor free during the visit. The facility's temperature read at 78 degrees; clients’ main restroom water temperature measured at 110.3 degrees. All cleaning solutions were locked in a secured area. Random smoke and carbon monoxide detectors were inspected and found to be in working order. LPA inspected the Fire Extinguishers and they were found to be in compliance. There were no bodies of water observed on the premise.

Items reviewed/discussed: Staff present have a criminal record clearance in file and are associated to the facility. All required postings were posted throughout the facility. Drills are conducted monthly and the last fire drilled was conducted on 9/14/2023. Random clients, facility and staff's records were reviewed and found to be complete. The facility does not have firearm and/or ammunition on grounds. There are no medication being administered to client in care. Annual fees are current. The facility has a current infection control plan on file.

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 to Program Coordinator, Alicia Rivas.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2023
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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