374603344-12-3-2024-08-AS-MGCO-DBM2SN-20241203163925

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374603344
Report Date: 12/03/2024
Date Signed: 12/03/2024 04:40:59 PM

Document Has Been Signed on 12/03/2024 04:40 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	A WINSOME ASSISTED LIVING COMMUNITY		FACILITY NUMBER:	374603344
ADMINISTRATOR/ DIRECTOR:	GUIA IGBANTE-ENRIQUEZ		FACILITY TYPE:	740
ADDRESS:	3808 SWEETWATER ROAD		TELEPHONE:	(619) 434-6560
CITY:	BONITA	STATE: CA	ZIP CODE:	91902
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 6	DATE:	12/03/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	House Manager, Jessica Enriquez		TIME VISIT/ INSPECTION COMPLETED:	12:25 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) Marisela Garcia-Centeno conducted an unannounced Required Annual Inspection. The facility file was reviewed before the visit. LPA identified herself and was granted entry by Caregiver, Irma Sunga. LPA explained the purpose of the visit to Jessica Enriquez, House Manager According to the facility’s license, the facility has a maximum capacity of six (6) elderly residents ages 60 and above; one (1) of whom may be bedridden in room #5 only. During today’s inspection, there were a total of six (6) residents in care, of which one (1) was ambulatory. Four of the residents were present at the facility other two (2) residents were at the day program. The facility does not feature a secured perimeter or delayed egress doors. LPA Garcia-Centeno was accompanied by the administrator, Enriquez while touring the interior and exterior of the facility. In addition, the residents’ rooms were inspected. The facility was clean and in good repair. Pathways were free of obstruction and slip hazards. The residents’ bedrooms contained the required furnishings. The doors, toilet, and shower were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and activities for the residents in care. The facility’s internal temperature and refrigerator and freezer temperatures were within the regulatory range. During today’s visit, LPA observed, via measurement with a thermometer, that the hot water temperature from the kitchen faucet accessible to residents was within regulatory range. (continue at LIC809C)

Jennifer Lott	TELEPHONE: (619) 346-3976
Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
	DATE: 12/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: A WINSOME ASSISTED LIVING COMMUNITY	FACILITY NUMBER: 374603344
	VISIT DATE: 12/03/2024

NARRATIVE

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(continue from LIC809)

There were at least 2 days of perishable food, and at least 7 days of non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, or open-faced heaters accessible to residents. Medications were labeled, as required and stored in locked areas.

Confidential residents and staff records were appropriately stored. No pools or bodies of water were observed on the premises. Per the administrator, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. The fire extinguisher was purchased within the last 12 months. The first aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA interviewed staff and residents present during the visit and reviewed staff and residents' records. LPA interviews did not raise any licensing concerns. The residents' files that LPA reviewed contained the required documents. Staff records contained proof of current first aid training. The administrator presented proof of current/active business liability insurance as required by Title 22 regulations. LPA provided technical assistance to licensee Igbante-Enriquez regarding keeping personnel records updated with required training, and maintaining all facility records at the facility.

No deficiencies were cited or observed on this date.

The Licensee was provided a copy of her appeal rights (LIC9058 03/22). An exit interview was conducted with House Manager, Enriquez, and a copy of this report was provided at the end of the visit.

SUPERVISOR'S NAME: Jennifer Lott	TELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2024

LIC809 (FAS) - (06/04)

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