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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603729
Report Date: 06/25/2024
Date Signed: 06/25/2024 01:14:16 PM

Document Has Been Signed on 06/25/2024 01:14 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 ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:ESPERANZA CRISIS CENTERFACILITY NUMBER:
374603729
ADMINISTRATOR/
DIRECTOR:
NYX, ANDREWFACILITY TYPE:
772
ADDRESS:490 N GRAPE STTELEPHONE:
(760) 975-9939
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY: 16CENSUS: 12DATE:
06/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:20 AM
MET WITH:Amber Berry, Program DirectorTIME VISIT/
INSPECTION COMPLETED:
01:15 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 Program Director, Amber Berry who was informed of the purpose of the visit. At the time of visit there was five (5) staff and eleven (11) clients present.

The facility is one story and has eight (8) bedrooms that are shared, up to two (2) clients to a room, and three (3) bathrooms. 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. Front entrance, interior, and exterior surroundings were also observed to be clean with no pathway obstruction. The facility does not have firearms and or ammunition on the grounds. 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 records were reviewed and were observed to contain required 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 107 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. All required postings, were posted near the entryway and throughout the facility. LPA inspected medications and medications appear to be dispensed appropriately according to physician's orders.



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: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/25/2024
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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