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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603127
Report Date: 07/31/2023
Date Signed: 07/31/2023 01:04:04 PM

Document Has Been Signed on 07/31/2023 01:04 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
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:ARC OF SAN DIEGO-NORTH COUNTY TRAINING CENTER, THEFACILITY NUMBER:
374603127
ADMINISTRATOR:KRISTEN KACIREKFACILITY TYPE:
775
ADDRESS:1336 RANCHEROS DRIVE, STE 100TELEPHONE:
(760) 740-6800
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY: 200CENSUS: 36DATE:
07/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Kristen Kacirek - Program DirectorTIME COMPLETED:
01:25 PM
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Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced required visit to the facility for the purpose of an annual inspection. LPA met with Program Director Kris Kacirek was informed of the purpose of the visit. At the time of the visit there was seven (7) staff and thirty-six (36) clients present.

LPA toured the facility inside and out and conducted staff and client interviews. The facility has no bodies of water or firearms and ammunition on the premises. The facility has multiple charged fire extinguishers and operating fire alarms/carbon monoxide detectors. Director Kacirek stated the fire department inspects their facility annually. Outdoor and indoor passageways were kept free of obstruction. Outdoor activity space was free of hazards and had shade cover for the clients. Cleaning supplies, medications, and the sharp and dangerous objects were kept locked and inaccessible to the clients. Facility has the proper staff to client ratio as required by Title 22 regulations.

Centrally stored medications are kept in the office and is locked in a cabinet. The facility currently dispenses medications for two (2) clients. LPA reviewed client medications for two (2) clients and found all medication listed on MARS and all required labeling was found to be in place.

LPA observed safe and healthy indoor activity space for the clients. LPA observed designated areas and classrooms where activities such as music, fitness, arts and crafts, computer lab, sensory room, and zoom classes take place. LPA also observed isolation and changing rooms. LPA toured the kitchen area. Clients bring their own food for both snacks and lunch but the facility provides snacks and emergency food for the clients if needed.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Sara Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 07/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ARC OF SAN DIEGO-NORTH COUNTY TRAINING CENTER, THE
FACILITY NUMBER: 374603127
VISIT DATE: 07/31/2023
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Bathrooms and kitchen area were maintained in safe and sanitary conditions with hand washing supplies and hand hygiene signs posted. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements. LPA measured the hot water temperature and recorded at 109.4 F.

LPA reviewed staff and client files. Facility has digital files and based on LPA's record review the staff files had all the required documentation including criminal record clearance and current first aid/CPR certification. Client files had all the required documentation and paperwork needed such as admission agreement, health screening, and current IPP.

LPA reviewed the facility's emergency and disaster plan that is posted throughout the facility. LPA reviewed documentation showing the facility's last fire and earthquake drills, which met the department requirements. LPA observed all facility exits were clear from obstructions. LPA observed multiple complete first aid kits and emergency supplies.

No deficiencies were cited during this visit.

An exit interview was conducted where a copy of this report was provided to Program Director, Kris Kacirek.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Sara Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2023
LIC809 (FAS) - (06/04)
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