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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604146
Report Date: 05/19/2022
Date Signed: 05/19/2022 12:58:49 PM


Document Has Been Signed on 05/19/2022 12:58 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:ATLANTIK CAREFACILITY NUMBER:
374604146
ADMINISTRATOR:SCOTT, JANET PFACILITY TYPE:
740
ADDRESS:461 ESTRELITA DRTELEPHONE:
(760) 295-4587
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:12CENSUS: 6DATE:
05/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Romelita Galapon, CaregiverTIME COMPLETED:
01:05 PM
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On 05/19/22 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct an annual inspection focused on infection control. LPA was greeted and granted entry by Caregiver George Galapon. LPA met with Caregiver Romelita Galapon and explained the purpose of the visit. The Administrator was available during the telephone via LPAs visit. At the time of visit there was 2 staff and 6 residents present. The facility currently has zero positive or suspected Covid-19 cases.

During today's visit, LPA discussed the expectation for the facility to submit their LIC808 mitigation plan to have on file and for review for staff, residents and visitors. The due date for the facility to submit their mitigation plan is Monday 5/23/22, by 5:00pm.

LPA toured the facility and made observations regarding the infection control measures that the facility has implemented. LPA observed Covid-19 postings posted throughout the facility. Upon entry there is a hand washing station and temperature screening for staff and visitors.

The facility staff are using EPA approved cleaners to clean and disinfect the facility at minimum of three times a day. LPA observed that FIT testing had not been completed for staff. LPA provided PIN 21-10-ASC that provides resources to access FIT testing.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and a copy of this report was provided to Caregiver Romelita Galapon.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:
DATE: 05/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/19/2022
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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