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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603587
Report Date: 02/28/2025
Date Signed: 02/28/2025 05:21:06 PM

Document Has Been Signed on 02/28/2025 05:21 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:CHANCELLOR HOMEFACILITY NUMBER:
374603587
ADMINISTRATOR/
DIRECTOR:		ASTRID GARCIAFACILITY TYPE:
735
ADDRESS:13904 CHANCELLOR WAYTELEPHONE:
(858) 842-4534
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 4CENSUS: 3DATE:
02/28/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH: Direct Support Professional (DSP) D'Ana NunezTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced Required Annual Inspection. LPA identified herself and was welcomed by DSP D'Ana Nunez to whom was explained the purpose of the visit. According to the facility’s license, the facility has a maximum capacity of four (4) clients, of which all may be non-ambulatory. The facility had a total of three (3) clients in care, one (1) of which was present during the visit.

LPA, accompanied by, 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, screens, toilets, and showers were in working order and in good repair. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. Hot water temperature at taps accessible to clients were all compliant: Bathrooms used by client's hot water measured at 110 F, and the facility’s ambient internal temperature was 76 degrees.

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



[Continued on LIC 809C]
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: CHANCELLOR HOME
FACILITY NUMBER: 374603587
VISIT DATE: 02/28/2025
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[Continuation of LIC 809]

No pools or bodies of water were present. Per DSP Nunez there was no ammunition kept at the facility. Smoke alarms, carbon monoxide detectors, and facility telephone were all operable. Fire extinguisher(s) were serviced within the last 12 months. Required licensing postings were observed in visible areas of the facility. All required records for clients and staff were present and current.

No deficiencies were cited during today's annual inspection.

An exit interview was conducted with DSP Nunez to whom a copy of this report and Licensee/Appeal Rights (LIC9058 03/22) will be provided. Signature below confirms receipt of the reports.

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025
LIC809 (FAS) - (06/04)
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