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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603127
Report Date: 08/22/2022
Date Signed: 08/22/2022 11:44:03 AM

Document Has Been Signed on 08/22/2022 11:44 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:ARC OF SAN DIEGO-NORTH COUNTY TRAINING CENTER, THEFACILITY NUMBER:
374603127
ADMINISTRATOR:ORCUTT, LAURAFACILITY TYPE:
775
ADDRESS:1336 RANCHEROS DRIVE, STE 100TELEPHONE:
(760) 740-6800
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY: 200CENSUS: DATE:
08/22/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Melanie McCoy - Senior Director of Adult Day Services & Kris Kacirek - North County Program AdministratorTIME COMPLETED:
11:30 AM
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On today's date, Licensing Program Analyst (LPA) Crystal Colvin and Licensing Program Manager (LPM) Joel Esquivel, met with facility representatives Melanie McCoy, Senior Director of Adult Day Services, and Kris Kacirek, North County Program Administrator, via Microsoft Teams in order to discuss recent concerns with reporting staff COVID-19 positive(s) and timely response to Licensing with requested information.

On 8/10/22, when conducting the 15-day follow-up call for a recent COVID-19 positive case, the assigned LPA discovered that a staff (S1) at the facility had tested positive for COVID-19 the week prior, which was not reported to Licensing. As of 8/18/22. Licensing had still not been able to obtain all information requested from the facility, and was being redirected back and forth between the facility site staff and headquarters staff. Licensee representatives Melanie McCoy and Kris Kacirek confirmed that all managers/supervisors will be updated on requirements for reporting COVID-19 positives to ensure that the information is forwarded to Licensing in a prompt manner.

During today's meeting it was additionally discussed that several documents need to be submitted to Licensing to document Kris Kacirek as the facility's currently appointed Administrator. Staff were instructed to email the required documents to LPM Esquivel to ensure processing. Additionally, per facility representatives request, LPA Colvin will update the facility's contact information to reflect Administrator's extension (x9311) and mobile number to be the Administrator's mobile number.

An exit interview was conducted and a copy of this report was provided to Administrator Kris Kacirek via email and signature was obtained.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2022
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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