374603621-4-15-2024-08-AS-RSEO-D4CSZQ-20240415141931

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374603621
Report Date: 04/15/2024
Date Signed: 04/15/2024 02:19:49 PM

Document Has Been Signed on 04/15/2024 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	ACI		FACILITY NUMBER:	374603621
ADMINISTRATOR/ DIRECTOR:	TAMARA ANDERSON		FACILITY TYPE:	775
ADDRESS:	296 H STREET, #101		TELEPHONE:	(619) 409-4100
CITY:	CHULA VISTA	STATE: CA	ZIP CODE:	91910
CAPACITY: 90		CENSUS: 60	DATE:	04/15/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:38 AM
MET WITH:	Tamara Anderson		TIME VISIT/ INSPECTION COMPLETED:	02:28 PM

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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, and discussed the purpose of the visit with Administrator Tamara Anderson.

According to the facility’s license, there may be a maximum of ninety (90) developmentally disabled adults at any given time at the day program site, four (4) of whom may be non-ambulatory. During today’s inspection, there were sixty (60) clients present at the day program site. The facility does not feature a secured perimeter or delayed egress doors.

LPA, accompanied by the Administrator, toured the interior and exterior of the facility. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Doors, windows and screens, sinks, and toilets were in working order. Hand hygiene supplies and Personal Protective Equipment were present. The facility had sufficient space and equipment to facilitate meetings and client activities. The facility’s ambient internal temperature was comfortable and compliant, at 71 degrees F. Hot water temperature at taps accessible to clients were also compliant: Kitchen sink was 105 degrees F, restroom sinks deliver hot water at 105 degrees F. Some consumers take medications (prescription) at the program, LPA inspected the medication room and found that medications were properly labeled and stored in a locked cabinet.

No pools or bodies of water on the premises. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients.

[CONTINUED ON LIC809-C]

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

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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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: ACI	FACILITY NUMBER: 374603621
	VISIT DATE: 04/15/2024

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[CONTINUED FROM LIC809]

accessible to clients. Per the Administrator, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguishers (3) were serviced within the last 12 months. First aid kits were complete and readily accessible.

LPA interviewed multiple staff and clients. LPA interviews did not raise any licensing concerns. LPA reviewed multiple staff and client records/files. The files contained required documents. Confidential records were stored in locked areas. Required licensing postings were observed in visible areas of the facility.

No deficiencies were observed or cited during today's visit.

An exit interview was conducted with Tamara Anderson, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

LIC809 (FAS) - (06/04)

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