<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603323
Report Date: 07/22/2021
Date Signed: 08/02/2021 04:38:56 PM

Document Has Been Signed on 08/02/2021 04:38 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:BARON'S PRESIDIO UNIVERSITY CITYFACILITY NUMBER:
374603323
ADMINISTRATOR:NARMINA MAMEDOVAFACILITY TYPE:
740
ADDRESS:6860 CONDON DRIVETELEPHONE:
(858) 558-4772
CITY:SAN DIEGOSTATE: CAZIP CODE:
92122
CAPACITY: 6CENSUS: 6DATE:
07/22/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Alma Meza, CaregiverTIME COMPLETED:
02:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Laarni Santiago visited the facility to conduct an annual required licensing inspection. LPA was granted entry into the facility and met with Alma Meza, Caregiver, with whom she discussed the purpose of the visit.

During today's visit, LPA toured the facility to verify compliance with infection control practices. LPA and facility staff reviewed the facility’s Plan for Epidemic Outbreak Specific to COVID-19 Mitigation. LPA observed one central entry point for universal entry screening; LPA reviewed the routine symptom screening initiated at entry for staff and residents; signs in the facility to promote hand hygiene, cough/sneeze etiquette and physical distancing; hand sanitizer/hand washing stations readily available; available visitation areas; emergency agencies’ contact information visible to staff; and an adequate supply of cleaning products. Additional PPE supplies were distributed to the facility.

No deficiencies were cited during today’s visit; however, facility representative was advised about symptom screening, temperature checks, and hand washing or hand sanitizing by visitors; Licensee was also advised of the need for staff to wear face coverings while in the facility and implement a visitor policy. An exit interview was conducted with Alma Meza, and a copy of this report and Licensee Rights (LIC 9058 FAS 01/16) were provided to the House Manager and Licensee via email following the visit. An electronic receipt of confirmation was requested to be sent to LPA upon receipt of the documents.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Laarni Santiago
LICENSING EVALUATOR SIGNATURE: DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/22/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1