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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603213
Report Date: 11/13/2023
Date Signed: 11/13/2023 12:20:00 PM

Document Has Been Signed on 11/13/2023 12:20 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:SANTA MARGARITA A.R.F.FACILITY NUMBER:
374603213
ADMINISTRATOR:VALENZUELA, DAVIDFACILITY TYPE:
735
ADDRESS:984 W 2ND AVETELEPHONE:
(760) 747-0440
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY: 6CENSUS: 6DATE:
11/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:24 AM
MET WITH:LICENSEE, SUSAN BEALSTIME COMPLETED:
12:24 PM
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On November 13, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the required annual inspection and met with the Licensee, Susan Beals. The LPA introduced herself and stated the purpose of the visit.

LPA Mixson toured the facility along with the Administrator, David and inspected the facility inside and outside, and there were no obstructions to the indoor or outdoor passageways at the time of this visit. The facility is a single-story home, located at 984 West 2nd Ave, Escondido, CA. 92025. Physical Plant: The facility phone number is (760) 747-0440 and is operable. The LPA observed the resident bedrooms, and they are equipped with required furniture as per Title 22. The LPA inspected two facility bathrooms, and the hot water temperature was tested and tested within regulations. The bathrooms were clean and appliances were operating appropriately at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguishers. The LPA observed required postings such as "If you See Something, Say Something" and the "Personal Rights" postings were posted in a common area. The cleaning supplies and sharp items were kept locked and inaccessible to the residents. There was a designated storage space for the resident and staff files. Medications: were locked and inaccessible to residents. The overall facility is clean, the furniture is in good condition. The facility air conditioning and other appliances were operable currently at the time of this visit. Food Service: Non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents. Dishes and utensils were in sufficient supply and stored properly. Care & SupervisionFacility has sufficient staff, three at the time of this visit, and all residents are in community at the day program. Records Review: The LPA reviewed four resident files, and one staff file. There was no Title 22, Division 6 Regulation violations observed and/or cited during today’s visit.
An exit interview was conducted and a copy of this report was given to the Licensee, Susan Beals.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2023
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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