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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604106
Report Date: 01/11/2024
Date Signed: 01/11/2024 12:25:43 PM

Document Has Been Signed on 01/11/2024 12:25 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: 60CENSUS: 45DATE:
01/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:LEAD STAFF, MARIBEL NAMBOTIME COMPLETED:
12:30 PM
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On January 11, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived to the Day Program unannounced in order to conduct the required annual inspection. LPA Mixson met with the Maribel Nambo, introduced self, and stated the purpose of the visit. The File review was conducted in the office and additional forms were requested and reviewed on site.

LPA Mixson toured the facility, along with the Maribel, and inspected the inside and outside of the facility. The facility is a single story building located at 1221 W. Vista Way Vista, CA. 92084. The facility phone number is (760)659-6976 and it is operable.
Physical Plant: The physical plant, is in good condition, neat, and orderly. Outdoor and indoor passageways are free of obstruction at the time of this visit. The day program activity rooms have the required furniture; such as tables, chairs, storage space, and sufficient lighting. The building temperatures throughout was per regulations. The activity rooms are equipped with the required items, per Title 22. The hot water temperature was tested in several of the restrooms, in which they each tested within the range required for regulations. The restrooms were equipped with liquid soap and paper towels. LPA Mixson toured the kitchen and staff were preparing lunch. The facility had activity schedules posted and available for review. The day program has emergency food and water. LPA Mixson inspected the common areas. The fire extinguisher was in the green and the program recently had fire inspection. Carbon monoxide alarms, along with smoke detectors were observed. There was a locked and centralized storage area for medications. Medications are contained in bubble packs, and supplied by the residents facility. The day program had a designated area for resident and staff files, and it was locked. Emergency disaster plans, personal rights, and complaint procedures were posted in a prominent area. There was adequate seating in the common areas and sufficient space for activities. LPA Mixson observed monthly activity calendars. LPA Mixson reviewed five staff files, five resident files, and conducted five staff interviews and one resident interview due to the residents being busy with meals and activities. There were no regulation violations observed during todays visit. An exit interview was conducted and a copy of this report was provided to Maribel Nambo.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/11/2024
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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