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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603127
Report Date: 07/22/2024
Date Signed: 07/22/2024 11:32:58 AM

Document Has Been Signed on 07/22/2024 11:32 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:ARC OF SAN DIEGO-NORTH COUNTY TRAINING CENTER, THEFACILITY NUMBER:
374603127
ADMINISTRATOR/
DIRECTOR:		KRISTEN KACIREKFACILITY TYPE:
775
ADDRESS:1336 RANCHEROS DRIVE, STE 100TELEPHONE:
(760) 740-6800
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY: 200CENSUS: 52DATE:
07/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Program Administrator, Kris KacerikTIME VISIT/
INSPECTION COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with Program Administrator Kris Kacerik who was informed of the purpose of the visit.

The facility is a one story building with activity rooms, staff offices, bathrooms, s and outdoor space. The program has a activity section with senior clients and adult developmental center. No pools or firearms are being kept at the facility. The facility does not provide meal services to clients.

Infection Control: The LPA observed the hand washing stations in the facility, hygiene supplies, PPE equipment and cleaning supplies through the facility to do regular cleaning of the facility. LPA reviewed the completed infection control training and infection control plan for the facility.



Physical Plant: Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. LPA observed client cubbies and clients in the common areas of the facility. The outdoor area is gates and provides shade for clients. No sharp and dangerous objects were observed to be out or accessible to clients. The hot water temperature was read in (2) client restrooms reading 105F and 109F.

Food Service: LPA observed facility kitchenettes had the ability to prepare food in clean environment and safe environment. LPA observed the facility snacks, storage space.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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: 07/22/2024
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Health Related Services/ Incidental Medical Services: Client medication was locked in a staff file cabinet. Client medications for was accounted for on electronic MARS log.

Care & Supervision/Administration: Adequate staff are present for the supervision of clients during the visit. The administrator's file and training met the department requirements.

Record Review and Resident/Staff Files: LPA reviewed (5) staff files and training. All staff have criminal clearance, CPR/First Aid Certification, and health screening. (5) client files were reviewed and had program goals, admission agreement, and medical assessments.

Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing the facility's last emergency drill conducted June of 2024. LPA observed all facility exits were clear from obstructions. LPA observed first aid kit, and AED machines in the facility.

No deficiencies were cited at the time of the visit. An exit interview was conducted where this report was reviewed and provided.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024
LIC809 (FAS) - (06/04)
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