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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604106
Report Date: 01/11/2023
Date Signed: 01/11/2023 02:43:05 PM

Document Has Been Signed on 01/11/2023 02:43 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
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:
01/11/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:ADMINISTRATOR, MARIBEL NAMBOTIME COMPLETED:
03:00 PM
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On January 11, 2023, Licensing Program Analyst (LPA), Venus Mixson conducted an unannounced case management visit to increase the capacity per licensee request. LPA Mixson met with Administrator, Maribel Nambo introduced self and explained the purpose of the visit. At the time of visit there were 28 residents present and 13 staffs.

Licensee requested for a capacity increase from 45 residents to 60 residents. A Fire Clearance was approved on 10/10/2022 for the increase. The facility sketch on file shows sufficient square footage in the facility and three activity rooms and a large lobby to accommodate the requested capacity. LPA Mixson discussed the facility sketch with Administrator which provided ample space for the 60 residents. The facility has numerous activity rooms and one offices. LPA Mixson confirmed that all activity rooms have an exit to the outside of the facility. LPA Mixson toured the interior/exterior of the building and visually inspected the over all facility. LPA Mixson confirmed that there are sufficient restroom in the facility to meet Title 22 requirements for ratio of residents to restrooms.

The physical plant is ready for increase in capacity. LPA Mixson will submit file for capacity increase approval. The final approval of capacity increase is contingent upon the Regional Office's final file review. Administrator will be notified by the Regional Office once capacity increase has been approved by licensing. If capacity increase is approved, new license will follow in the mail after phone notification by LPA Mixson with Administrator.

An exit interview was conducted and a copy of this report was provided to Administrator.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 01/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2023
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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