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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603572
Report Date: 06/02/2022
Date Signed: 06/30/2022 11:13:26 AM

Document Has Been Signed on 06/30/2022 11:13 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
CCLD Regional Office,
, CA
FACILITY NAME:AVID BEHAVIORAL DAY PROGRAMFACILITY NUMBER:
374603572
ADMINISTRATOR:SARAI MARCELINFACILITY TYPE:
775
ADDRESS:562 W GRAND AVENUETELEPHONE:
(442) 999-5740
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY: 45CENSUS: 35DATE:
06/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Sarai Marcelin, LicenseeTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Carmen Lopez made an unannounced visit to the facility to conduct an annual required licensing inspection. LPA identified herself and was granted entry by Maribel Nambo, Administrator. LPA met with Administrator Nambo and discussed the purpose of today’s visit. Licensee Sarai Marcelin later arrived and joined the inspection.

A tour of the day program was conducted. LPA accompanied by Administrator conducted a general overall inspection, with specific focus on infection control protocols.

During today's inspection LPA observations include the following: Symptom screening procedures for staff, clients and visitors; posted signs regarding visitor policy, promoting hand washing/hygiene practices, cough and sneeze etiquette and other infection control procedures; 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. An exit interview was conducted with Licensee Marcelin and a copy of this report, along with the Licensee Rights (01/2016) was provided to Licensee at the conclusion of the visit. The signature below confirms receipt of the documents.

LPA requested Licensee to submit a current Emergency Disaster Plan LIC 610-D to the licensing office within 10 business days. A Designation of Administrative Responsibility LIC 308 and Personnel Report LIC 500 forms were provided to LPA Lopez during the visit. Forms are available at www.ccld.ca.gov.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/02/2022
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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