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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603328
Report Date: 03/19/2024
Date Signed: 04/03/2024 11:49:16 AM


Document Has Been Signed on 04/03/2024 11:49 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 04/03/2024 10:51 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

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's (LPA) Ryan Fulton and Nacole Patterson conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPAs were welcomed by and discussed the purpose of the visit to Caregiver Erika Garcia during the visit LPA's spoke to Licensee Richard Axtell over the phone and then in person later during the visit. The facility's license shows a maximum capacity of six (6) non-ambulatory residents, one (1) of whom may be bedridden in room #1 or #4 only. During today’s inspection there were six (6) residents in care.

LPAs and Caregiver Erika Garcia toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per caregiver Yulissa Colon Ramirez, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. First aid kit(s) were complete and readily accessible. Technical assistance and technical violations were provided regarding fire extinguisher checks, infection control, facility records, and required licensing postings.

LPAs interviewed staff and clients, and reviewed client facility records. The files reviewed by LPAs contained required documents. Confidential records were stored in locked areas.

Deficiencies were cited per California Code of Regulations, Title 22 (refer to the attached LIC809-D). An exit interview was conducted with Licensee Richard Axtell, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided. This is an amended report for facility visit conducted on 3/19/24.
SUPERVISOR'S NAME: Leann RayleTELEPHONE: (619) -76-2311
LICENSING EVALUATOR NAME: Ryan FultonTELEPHONE: 619-629-8938
LICENSING EVALUATOR SIGNATURE:
DATE: 03/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/19/2024
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 2