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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603344
Report Date: 12/03/2021
Date Signed: 12/03/2021 11:46:24 AM

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:A WINSOME ASSISTED LIVING COMMUNITYFACILITY NUMBER:
374603344
ADMINISTRATOR:GUIA IGBANTE-ENRIQUEZFACILITY TYPE:
740
ADDRESS:3808 SWEETWATER ROADTELEPHONE:
(619) 434-6560
CITY:BONITASTATE: CAZIP CODE:
91902
CAPACITY:6CENSUS: 6DATE:
12/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Guia Ugbante-EnriquezTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Kennedy made an unannounced visit to the facility to conduct an annual required licensing inspection. LPA identified herself, and met with Guia Ugbante-Enriquez, Licensee and Administrator and discussed the purpose of today’s visit.

A tour of the facility was conducted inside and out. LPA, accompanied by facility staff conducted a general overall inspection, with a specific focus on infection control.

During today's inspection LPA observations include the following: Symptom screening procedures for staff, residents and visitors; posted signs including visitor policy, promoting hand washing, cough and sneeze etiquette and other infection control procedures; Hand hygiene practices; testing plan and procedures; plans for containing infections, PPE supplies procedures and training; and disinfection procedures.


Based on today’s inspection, no deficiencies were observed at this time in the areas evaluated. This report was discussed with Guia Ugbante-Enriquez, Licensee and Administrator . A copy along with Licensee Rights (01/2016) was emailed to Ms. Ugbante-Enriquez at the conclusion of the visit. An electronic response confirms the receipt of these documents.


Please submit a current Designation of Administrative Responsibility LIC 308, Personnel Report LIC 500 and Emergency Disaster Plan LIC 610-E to the licensing office within 10 business days. Forms available at www.ccld.ca.gov
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Anna KennedyTELEPHONE: (619) 997- 4108
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
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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