374603492-2-9-2024-08-AS-JBAD-D2APDH-20240209101332

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374603492
Report Date: 02/08/2024
Date Signed: 02/09/2024 10:13:48 AM

Document Has Been Signed on 02/09/2024 10:13 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	SUMMER PLACE		FACILITY NUMBER:	374603492
ADMINISTRATOR:	DRAGANA LEKOVIC		FACILITY TYPE:	740
ADDRESS:	1739 SUMMER PLACE DRIVE		TELEPHONE:	(619) 596-0742
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92021
CAPACITY:	9	CENSUS: 8	DATE:	02/08/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Administrator Alex Boskoski		TIME COMPLETED:	04:15 PM

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Licensing Program Analyst (LPA) Juliana Barfield conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Administrator Alex Boskoski.

According to the facility’s license, the facility has a maximum capacity of nine (9) clients, all of whom may be non-ambulatory. During today’s inspection, there were a total of eight (8) clients in care. This facility does not feature a secured perimeter or delayed egress doors.

LPA, accompanied by Alex Bokoski, 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 and 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’s ambient internal temperature was 72F. Hot water temperature at taps accessible to clients were all compliant: Kitchen sink was 114F, Bathroom #1 sink was 114F, and Bathroom #2 sink was 105F and Bathroom #3 sink was 113F.

Refrigerator temperature was 40F and freezer temperature was 0F. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas.

(CONTINUED ON LIC 809-C)

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Juliana Barfield	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

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: SUMMER PLACE	FACILITY NUMBER: 374603492
	VISIT DATE: 02/08/2024

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(CONTINUED FROM LIC809)

No pools or bodies of water were observed on the premises. Per the licensee's staff, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPAs interviewed multiple staff and clients. The interviews did not raise any significant licensing concerns. LPA reviewed multiple staff and client records/files.The reviewed files contained most of the required documents. Confidential records were stored in locked areas. Boskoski also presented proof of current/active business liability insurance.

No deficiencies were observed or cited during today's annual inspection. LPA issued two (2) technical violations.

An exit interview was conducted with Alex Boskoski, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Juliana Barfield	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

LIC809 (FAS) - (06/04)

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