<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603759
Report Date: 06/24/2024
Date Signed: 06/24/2024 04:16:12 PM

Document Has Been Signed on 06/24/2024 04:16 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:DAYBREAK VILLA EASTFACILITY NUMBER:
374603759
ADMINISTRATOR/
DIRECTOR:
CORPUZ, ROLANDOFACILITY TYPE:
740
ADDRESS:1682 DAYBREAK PLACETELEPHONE:
(760) 781-1079
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY: 6CENSUS: 5DATE:
06/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Rommel Abedoza, Lead CaregiverTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Jacqueline Shaw Ross arrived at the facility unannounced to conduct an annual inspection. LPA was greeted by Rommel Abedoza, Lead Caregiver and the purpose of the visit was explained. Present at the facility were two (2) staff members and five (5) clients. LPA conducted staff and client interviews. The facility is a one story five (5) bedroom, four (4) bathroom home. There is one bedroom shared by two (2) clients. A tour of the facility was conducted inside and out. The smoke alarm system was tested and found operable. Hot water temperature was tested at 118.9 degrees Fahrenheit.

LPA reviewed staff and client records. Review of staff records indicate all staff have criminal record clearances and are appropriately associated to the facility. Staff files had the required documentation including First Aid Certifications and training documents that included recent training. Review of the facility training binder showed the following refresher training completed include: Alzheimer's, Emergency Disaster, Postural Supports, Restricted Conditions, Hospice, Reporting Abuse, Food Handling, Dementia, Fall Prevention and Medication training. Review of client files revealed all client records are current and up to date. LPA inspected medications and medications appear to be dispensed appropriately according to physician's orders. The outdoor space is free of hazard. Emergency drills are conducted quarterly. Fire extinguishers are fully charged.

During the inspection, no deficiencies were observed. An exit interview was conducted and a copy of the report and LIC 811 was provided to facility staff.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2024
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 1