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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603607
Report Date: 07/03/2023
Date Signed: 07/03/2023 01:33:10 PM

Document Has Been Signed on 07/03/2023 01:33 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:FAMILY VALUES IIIFACILITY NUMBER:
374603607
ADMINISTRATOR:LORELIE MANAIGFACILITY TYPE:
735
ADDRESS:3302 YBARRA ROADTELEPHONE:
(619) 303-4261
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91978
CAPACITY: 6CENSUS: 6DATE:
07/03/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Administrator Lorelie ManaigTIME COMPLETED:
01:35 PM
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Licensing Program Analyst (LPA) Riza Alvarez conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was greeted and allowed entry into the facility by House Manager Flerida dela Vega, to whom LPA discussed the purpose of the visit. Administrator Lorelie Manaig arrived at the facility shortly.

According to the facility’s license, the facility has a maximum capacity of six (6) non-ambulatory, developmentally disabled adult clients. During today’s inspection, there was a total of two (2) clients in care, three (3) clients in day program, one (1) client on house pass until 7/6/23.

LPA, accompanied by F. dela Vega, 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. 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 compliant at 72 F. Hot water temperature at taps accessible to clients were all compliant: Kitchen sink was 108.5 F, bathroom #1 sink was 119.1 F and bathroom #2 sink was 119.7 F.

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, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas.

[CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Riza Gloria Alvarez
LICENSING EVALUATOR SIGNATURE: DATE: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2023
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: FAMILY VALUES III
FACILITY NUMBER: 374603607
VISIT DATE: 07/03/2023
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[CONTINUED FROM LIC 809]

No pools or bodies of water on the premises. Per F. dela Vega, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguishers (2) were serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA interviewed staff and clients present. LPA interviews did not raise any licensing concerns. LPA reviewed multiple staff and client records/files. The files reviewed contained required documents. Confidential records were stored in locked areas. Administrator presented proof of current/active business liability insurance and surety bond.

No deficiencies were observed or cited during today's annual inspection.

An exit interview was conducted with Administrator Manaig. Copies of this report and the Licensee/Appeal Rights (LIC9058 03/22) will be emailed by LPA Alvarez to Administrator Manaig (email address: mlorelie@yahoo.com) within the day.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Riza Gloria Alvarez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023
LIC809 (FAS) - (06/04)
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