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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603800
Report Date: 09/07/2021
Date Signed: 09/17/2021 09:45:29 AM

Document Has Been Signed on 09/17/2021 09:45 AM - 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:UNYEWAY INCFACILITY NUMBER:
374603800
ADMINISTRATOR:SWAFFORD, MARGIEFACILITY TYPE:
775
ADDRESS:1689 BROADWAY SUITE 106TELEPHONE:
(619) 691-6346
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 210CENSUS: 19DATE:
09/07/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Program Manager, Blanca VasquezTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an unannounced case management visit at the facility. LPA gained access to the facility and identified herself to Program Manager, Blanca Vasquez. LPA explained the purpose of the visit which was to follow-up on the Case Management visit on July 13, 2021.

The facility reported that on July 09, 2021, during afternoon transportation back home from the day program, Client 1 (C1) (See LIC 811 Confidential Names List) was dropped off by Staff 1 (S1) at the wrong address. C1 was later found in the surrounding area and returned home with no injuries reported.

The Department’s investigation consisted of records review, interviews with staff, clients and outside sources. A deficiency was cited during today's visit. See LIC 809D page for citation and plan of correction.

An exit interview was conducted with Program Manager and a copy of this report, LIC 809D, LIC 811 and Licensee/Appeal Rights (LIC9058 01/16) were provided via email. An electronic receipt of confirmation was requested to be sent by the Licensee upon receipt of the documents.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Elizabeth Hamilton
LICENSING EVALUATOR SIGNATURE: DATE: 09/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/07/2021
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 2
Document Has Been Signed on 09/17/2021 09:45 AM - It Cannot Be Edited


Created By: Elizabeth Hamilton On 09/07/2021 at 09:10 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: UNYEWAY INC
FACILITY NUMBER: 374603800

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/15/2021
Section Cited
CCR
82065

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82065 – Personnel Requirements (a) Program personnel shall be competent to provide services necessary to meet individual client needs… This requirement was not met as evidenced by:
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Licensee conducted refresher trainings on the transportation policy with each staff member individually which was completed on 07/15/2021 and verification was provided to the department. Licensee added a ride along with each driver to ensure clients are dropped off and directly walked to the correct address. Administrator stated S1 was terminated as of 07/13/2021.
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Based on interviews and records reviewed, licensee did not ensure program personnel (S1) was competent in providing transportation services to C1. This posed a potential safety risk to 1 out of 19 clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Denise Powell
LICENSING EVALUATOR NAME:Elizabeth Hamilton
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2021


LIC809 (FAS) - (06/04)
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