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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603586
Report Date: 10/21/2021
Date Signed: 10/21/2021 02:19:31 PM

Document Has Been Signed on 10/21/2021 02:19 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:BLAKEYS PLACE, ARFFACILITY NUMBER:
374603586
ADMINISTRATOR:BLAKEY, LEROYFACILITY TYPE:
735
ADDRESS:1420 PEERLESS DRIVETELEPHONE:
(619) 246-1171
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY: 6CENSUS: 4DATE:
10/21/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Leroy Blakey, LicenseeTIME COMPLETED:
02:20 PM
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Licensing Program Manager (LPM) Denise Powell and Licensing Program Analyst (LPA) Esther Iriarte-Rendon conducted an unannounced annual required inspection on today's date. LPA and LPM were greeted at the front door and granted entry after identifying themselves and disclosing the purpose of the visit. An overall tour of the facility was conducted. The inspection included, but was not limited to, verifying compliance with statutes, regulations and other requirements most relevant to protecting the health of residents in care and staff, including in the area of infection control practices.

LPM reviewed with Leroy Blakey, Licensee, the facility’s Plan for Epidemic Outbreak Specific to COVID-19 Mitigation Plan Report (LIC 808) including the following sections: Persons in Care, Staff, Visitors, Facilities without COVID-19, Residents, Facility Plans for Infection Control, and Physical Distancing. LPA assessed the strategies that the facility is employing for the prevention, containment and mitigation of COVID-19, implementation of infection control guidance, staff retention and essential health and safety.

LPM and LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff and visitors; a sign-in policy enacted for all visitors; signs posted at facility entrance with the facility’s visitor policy, and signs throughout the facility to promote hand hygiene, cough/sneeze etiquette and physical distancing; face coverings worn by staff; hand sanitizer/hand washing stations readily available; a designated visitation area; emergency agencies’ contact information posted in a location visible to staff and residents; and an adequate supply of PPE (Personal Protective Equipment). Based on observations, the facility is in compliance with and has implemented infection control practices as outlined in its LIC 808.

No deficiencies were observed during today's visit. An exit interview was conducted with Leroy Blakeyand a copy of this report along with Licensee/Appeal Rights (LIC 9058 FAS 01/16) was provided via email; facility representative expressed that they would send LPA a confirmation email upon receipt of these documents.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Esther Iriarte-Rendon
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2021
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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