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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603759
Report Date: 06/14/2023
Date Signed: 06/14/2023 06:24:46 PM


Document Has Been Signed on 06/14/2023 06:24 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:DAYBREAK VILLA EASTFACILITY NUMBER:
374603759
ADMINISTRATOR:CORPUZ, ROLANDOFACILITY TYPE:
740
ADDRESS:1682 DAYBREAK PLACETELEPHONE:
(760) 781-1079
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY:6CENSUS: 6DATE:
06/14/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
06:00 PM
MET WITH:Administrator, Rolando "Bobby" CorpuzTIME COMPLETED:
06:25 PM
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Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced visit to the facility in order to conduct a plan of correction visit. Deficiency were cited on 5/31/2023 during an informal office visit. The LPA met with Administrator, Rolando "Bobby" Corpuz who was informed of the purpose of the visit.

The following deficiency was corrected during today's POC visit:
Deficiency cited under Title 22 Regulation 87707(a) Advertising Dementia Special Care, Programming, and Environments. The POC made with the licensee was to hold an in-service with staff and themselves in attendance and send proof of this to the LPA by the POC due date 6/6/2023. The topics shall include: dementia care and fall risk prevention. On today's visit LPA spoke with administrator and look at training material received. LPA also received the POC by the due date to their email. POC was cleared and clearance letter was provided to administrator.

The following deficiencies were not corrected by the POC due date nor at the time of the visit. Civil Penalties are being assessed and will continue to accrue until correction has been submitted:

Deficiency cited under Title 22 Regulation 87405(a) Administrator- Qualifications and Duties. The POC made with the administrator was to spend 20 hours a week at the facility and to oversee Daybreak Villa East and West and remove themselves as administrator from the other (3) facilities. Proof of removal from facilities as administrator, LIC500 showing the 20 hours allotted per week. This was due by POC date 6/6/2023. On today's visit LPA spoke to administrator who stated they had sent the LPA LIC308 to designate their house managers in their place for other (3) facilities but had not disassociated themselves. POC documented has still not been received. Civil penalties are being assessed for the dates of 6/7/2023 to 6/14/2023 in the amount of $100 per day for 8 days. Civil penalties will continue to accrue at the rate of $100 corrections are made and sent to LPA.

An exit interview was conducted with administrator, Rolando "Bobby" Corpuz where this report and civil penalties were reviewed and provided.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2023
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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