374604023-6-6-2023-08-AS-RGAZ-CSJTQR-20230606145623

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604023
Report Date: 06/06/2023
Date Signed: 06/06/2023 02:56:29 PM

Document Has Been Signed on 06/06/2023 02:56 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
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	BRANDYWOOD HOME 2		FACILITY NUMBER:	374604023
ADMINISTRATOR:	GUITIERREZ, KINNAH		FACILITY TYPE:	735
ADDRESS:	4944 CLEARVIEW WAY		TELEPHONE:	(619) 263-7444
CITY:	LA MESA	STATE: CA	ZIP CODE:	91942
CAPACITY: 4		CENSUS: 4	DATE:	06/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Staff Victoria Rice		TIME COMPLETED:	03:00 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 (LPAs) Riza Alvarez conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Victoria Rice, Caregiver. Administrator Kinnah Gutierrez arrived at the facility shortly. According to the facility’s license, the facility has a maximum capacity of four (4) ambulatory clients. During today’s inspection, there was one (1) client in care, who was waiting for a medical appointment. Three (3) clients were out in the community. The facility fire clearance did not include permissions for secured perimeter or delayed egress doors, and none of these were present during today’s visit. LPA, accompanied by Administrator, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. Hot water temperatures at taps accessible to clients were compliant: Kitchen sink was 108 F, Bathroom sink was 108.1 F. The facility’s ambient internal temperature was compliant at 77 F. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. Kitchen appliances were working. [CONTINUED ON LIC 809-C]

SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Riza Gloria Alvarez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: BRANDYWOOD HOME 2	FACILITY NUMBER: 374604023
	VISIT DATE: 06/06/2023

NARRATIVE

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[CONTINUED FROM LIC 809]

There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas. Confidential staff and client records were stored in locked areas.

There is a pool on the premises. The pool area is fenced and locked. Per Administrator, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher was serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA interviewed staff and client present. LPA reviewed all client and staff records/files. LPA interviews did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in locked areas.

No deficiencies were observed or cited during today's annual inspection.

An exit interview was conducted with Administrator Kinnah Gutierrez, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Riza Gloria Alvarez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

LIC809 (FAS) - (06/04)

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