374604121-10-27-2023-08-AS-MGCO-CWZQXK-20231027123341

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604121
Report Date: 10/27/2023
Date Signed: 10/27/2023 12:35:45 PM

Document Has Been Signed on 10/27/2023 12:35 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	WINNETKA HOME		FACILITY NUMBER:	374604121
ADMINISTRATOR:	SEACORD, BRIAN		FACILITY TYPE:	734
ADDRESS:	3526 WINNETKA DR		TELEPHONE:	(619) 470-0804
CITY:	BONITA	STATE: CA	ZIP CODE:	91902
CAPACITY: 5		CENSUS: 5	DATE:	10/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Heather Harjer, LVN		TIME COMPLETED:	11:20 AM

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 (LPA) Marisela Garcia-Centeno conducted an unannounced required annual inspection. The facility file was reviewed prior to the visit. LPA identified herself and was granted entry by Licensed Vocational Nurse, Heather Harjer to whom she disclosed the purpose of the visit. According to the facility’s license, the facility has a maximum capacity of five (5) non-ambulatory of which five (5) may be bedridden. During today’s inspection, there were a total of five (5) clients in care of which four (5) were non-ambulatory. LPA, accompanied by Staff, Lisa Rheam, toured the interior and exterior of the facility and inspected the rooms. The facility was clean and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required medical equipment and furnishings to meet clients needs. The facility is equipped with two back up generators. The doors, toilet, and shower 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. The facility’s internal temperature and refrigerator and freezer temperatures were within the regulatory range. During today’s visit, LPA observed, via measurement with a thermometer, was within the regulatory range, at 107.6. There was at least 2 days of perishable food, and at least 7 days of non-perishable food present, all safely stored. There was plenty of food for clients at the facility. Cooking/dining equipment and utensils were present. There were no sharp objects, or toxic chemicals/poisons, accessible to clients. Medications were labeled, as required and stored in locked areas. Confidential records were appropriately stored. No pools or bodies of water were observed on the premises. (Continue at LIC809C)

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: WINNETKA HOME	FACILITY NUMBER: 374604121
	VISIT DATE: 10/27/2023

NARRATIVE

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Continue from LIC 809

Per the house manager, Ruth Rivera, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. The fire extinguishers (3) were serviced within the last 12 months. The first aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA interviewed staff and clients present during the visit and reviewed staff and client records. LPA interviews did not raise any licensing concerns. The client files that LPA reviewed contained the required documents. Staff records contained proof of current first aid training, the last training for which certification was maintained was during 2023. The administrator presented proof of current/active business liability insurance and current surety bond.

No deficiencies were cited during today's visit. An exit interview was conducted with Administrator, Brian Seacord, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the end of the visit.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

LIC809 (FAS) - (06/04)

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