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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602872
Report Date: 10/31/2024
Date Signed: 10/31/2024 02:08:54 PM

Document Has Been Signed on 10/31/2024 02:08 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:BRISA DEL SOLFACILITY NUMBER:
374602872
ADMINISTRATOR/
DIRECTOR:		SALVADOR ANTONFACILITY TYPE:
735
ADDRESS:38133 HIGHWAY 94TELEPHONE:
(619) 746-4664
CITY:BOULEVARDSTATE: CAZIP CODE:
91905
CAPACITY: 4CENSUS: 4DATE:
10/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:20 AM
MET WITH:Caregiver Alexandra CalderonTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Required Annual Inspection. The LPA introduced himself to Licensee Alexandra Calderon and disclosed the purpose of the visit. The facility was licensed for a capacity of four (4) clients, who may be non-ambulatory downstairs only. All clients were in day program at the time of the visit.

The LPA, accompanied by the licensee, toured the facility, and inspected each client bedroom. The facility
was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client 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.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored.
Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to clients.
Medications were labeled and stored in a locked area of the facility.

No pools, nor bodies of water were observed on the premises. Per staff, no firearms, nor ammunition were kept at the facility. A carbon monoxide detectors, emergency lighting, and facility telephone were all working.

The LPA interviewed staff and reviewed multiple staff and client records. The LPA provided technical advised regarding maintaining personnel records, emergency drill documentation, and maintaining the facility's disaster plan.

An exit interview was conducted with licensee Calderon, to whom a copy of this report and the Licensee/Appeal Rights
(LIC9058 03/22), were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2024
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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Document Has Been Signed on 10/31/2024 02:08 PM - It Cannot Be Edited


Created By: Sabel Martinez On 10/31/2024 at 01:35 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: BRISA DEL SOL
FACILITY NUMBER: 374602872

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/31/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80066(a)(10)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (10) A health screening as specified in Section 80065(g).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date:
Plan of Correction
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Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lizzette Tellez
LICENSING EVALUATOR NAME:Sabel Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/31/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/31/2024


LIC809 (FAS) - (06/04)
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