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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603789
Report Date: 09/01/2022
Date Signed: 09/01/2022 02:47:02 PM

Document Has Been Signed on 09/01/2022 02:47 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:LA MESA WORK CENTER ANNEXFACILITY NUMBER:
374603789
ADMINISTRATOR:SACOCO, DEONNAFACILITY TYPE:
775
ADDRESS:3403 E PLAZA BLVD SUITE HTELEPHONE:
(619) 267-7796
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY: 40CENSUS: 36DATE:
09/01/2022
TYPE OF VISIT:Case Management - COVID-19ANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator Deonna SacocoTIME COMPLETED:
01:50 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) Dang Nguyen conducted an announced Case Management visit, accompanied by nurse contractors Elizar Perez and Sandra Brackman from the Healthcare Associated Infection (HAI) team of San Diego County Health and Human Services Agency. LPA and HAI nurses were welcomed by, identified themselves to, and discussed the purpose of the visit with facility administrator Deonna Sacoco.

The Department conducted the on-site visit to provide technical assistance and to evaluate the facility's COVID-19 screening, testing, and disinfection processes and the staff’s use of personal protective equipment (PPE). During the visit, LPA and HAI nurses briefly toured the facility and interviewed the administrator. They also trained 13 facility staff on the topic of donning and doffing of PPE, using both demonstration and hands-on/tacticle skills practice. No deficiencies were cited on this date.

An exit interview was conducted with Sacoco, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2022
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