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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603729
Report Date: 06/23/2023
Date Signed: 06/23/2023 02:42:14 PM

Document Has Been Signed on 06/23/2023 02:42 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
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:ESPERANZA CRISIS CENTERFACILITY NUMBER:
374603729
ADMINISTRATOR:NYX, ANDREWFACILITY TYPE:
772
ADDRESS:490 N GRAPE STTELEPHONE:
(760) 975-9939
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY: 16CENSUS: 9DATE:
06/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Laura Cooke, Acting Program DirectorTIME COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA), Jacqueline Shaw Ross made an unannounced visit to the facility to conduct a required annual inspection. LPA was greeted and granted entry by Acting Program Director, Laura Cooke who was informed of the purpose of the visit. At the time of visit there was ten (10) staff and nine (9) residents present.

The facility is one story and has eight (8) bedrooms that are shared, up to two (2) clients to a room. LPA conducted a general overall inspection, which included, but was not limited to, the following: physical plant; interior and exterior, and records review. LPA Shaw Ross conducted staff and client interviews.

The facility appears clean and free of odors. LPA observed that the facility did not have any health and safety issues. Staff present have criminal record clearances and are appropriately associated to the facility. Staff files have the required documentation including First Aid Certifications and training documents. Client bedrooms are clean and appropriately furnished. Food and emergency supplies are sufficient. LPA observed all toxic chemicals and other hazards secured and inaccessible to clients. Medications are centrally stored in a locked cabinet in the nurse's office. Hot water was tested at 116 degrees Fahrenheit. Furniture in the facility is in good repair. Outdoor space is free of hazards. Smoke alarms are in working order. Fire extinguishers were examined to be up to date. The facility is completing emergency drills on a monthly basis.



LPA inspected medications and medications appear to be dispensed appropriately according to physician's orders. Dues are current.

During the inspection, no deficiencies were observed. An exit interview was conducted and a copy of the report and LIC 811 was provided.


SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2023
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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