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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604106
Report Date: 01/17/2020
Date Signed: 02/22/2022 11:37:18 AM

Document Has Been Signed on 02/22/2022 11:37 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:AVID BEHAVIORAL DAY PROGRAM VISTAFACILITY NUMBER:
374604106
ADMINISTRATOR:MAHARAI, LORENAFACILITY TYPE:
775
ADDRESS:1221 WEST VISTA WAYTELEPHONE:
(760) 691-9622
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY: 45CENSUS: DATE:
01/17/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Administrator, Maribel Nambo OnofreTIME COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA) Debbie Correia made an unannounced visit to the facility to conduct an annual licensing inspection. LPA identified herself and was granted entry and met with Administrator, Maribel Nambo Onofre whom was explained the purpose of the visit. The facility is licensed to forty-five (45) developmentally disabled adults ages 18 and above; fifteen (15) of whom may be non-ambulatory.

During today's visit LPA conducted a general overall inspection however, due to time constraints LPA was unable to complete the visit and will return at a later date to conduct the remaining portion of this inspection.

Based on today's inspection there are no deficiencies observed at this time in the areas evaluated. An exit interview was conducted, this report was discussed with Administrator, Maribel Nambo Onofre and a copy along with Licensee/Appeal Rights (LIC 9058 01/2106), and their signature on this form acknowledges receipt and a copy of the report was given to the Administrator, Maribel Nambo Onofre.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2020
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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