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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603520
Report Date: 01/09/2024
Date Signed: 01/10/2024 08:49:49 AM


Document Has Been Signed on 01/10/2024 08:49 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:VIBRANT LIVINGFACILITY NUMBER:
374603520
ADMINISTRATOR:NORRIS, JULIEFACILITY TYPE:
740
ADDRESS:5723 BOUNTY STREETTELEPHONE:
(619) 269-6915
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY:6CENSUS: 6DATE:
01/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Caregiver Jessica GaribayTIME COMPLETED:
12:15 PM
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Licensing Program Analysts (LPA) Iby Strong and Mark Mandel conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit with Caregiver Jessica Garibay. According to the facility’s license, the facility has a maximum capacity of six (6) residents, of whom all may be non-ambulatory.

LPAs 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. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities.

Cooking/dining equipment and utensils were present. Medications were labeled, as required, and stored in locked areas.



No pools or bodies of water on the premises. Per Caregiver, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit(s) were complete and readily accessible.

Administrator emailed staff records to LPA Strong. Resident records did not contain needs and services plans in 6 of 6 residents. There were toxic chemicals under the kitchen sink with an ineffective lock. Caregiver removed chemicals at request of LPAs and stored them in locked garage.



One technical violation (TV) for records and one technical advisory (TA) for physical plant was issued on today’s visit and An exit interview was conducted with Caregiver Jessica Garibay, to whom a copy of this report, LIC9102 and the Licensee/Appeal Rights (LIC9058 03/22, were provided to during the visit.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Iby StrongTELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2024
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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