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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603323
Report Date: 07/07/2022
Date Signed: 07/07/2022 10:44:44 AM


Document Has Been Signed on 07/07/2022 10:44 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, 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:
07/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Manager Agnieska NortonTIME COMPLETED:
10:55 AM
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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced Required 1 - Year visit. The LPA was greeted by Manager, Agnieska Norton, identified himself, and discussed the purpose of the visit.

During today's inspection, the LPA observed the following: Exterior and interior passageways were free from obstructions. All of the residents’ rooms were equipped with the required furnishings. Residents’ bathrooms were observed to be sanitary and operational. The facility was stocked with a 2-day supply of perishable and a 7-day supply of nonperishable food items. There were no pools, nor bodies of water accessible to residents. Per Manager, Agnieska Norton, there were no firearms, nor ammunition at the facility.

In accordance with the Department’s Infection Control program, the LPA provided technical assistance and observed and evaluated the facility's implementation of infection control practices. The LPA observed one central entry point for universal entry screening; Routine symptom screening initiated at entry for staff and visitors; a sign-in policy enacted for all visitors; Signs posted at facility entrance with the facility’s visitor policy, and signs throughout the facility to promote hand hygiene; Hand sanitizer/hand washing stations readily available; A designated visitation area; and emergency agencies’ contact information posted in a location visible to staff and residents. Based on observations, the facility is in compliance with and has implemented infection control practices.

An exit interview was conducted with Manager, Agnieska Norton, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided to.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 07/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/07/2022
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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