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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604146
Report Date: 03/06/2024
Date Signed: 03/06/2024 01:54:42 PM


Document Has Been Signed on 03/06/2024 01:54 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:
03/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:ADMINISTRATOR, JANET P. SCOTTTIME COMPLETED:
02:09 PM
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On March 06, 2024, Licensing Program Analyst (LPA), Venus Mixson conducted an unannounced Annual/Random Inspection, and met with Janet Scott, the Administrator.

The Facility currently has six elderly residents. Facility has a Hospice waiver for five and is approved for four bedridden residents. Facility's file review was conducted in the Regional Office and additional forms were reviewed and requested on site.

LPA Mixson toured the facility, along with the Janet, and inspected the inside and outside of the facility. The facility is a single-story building with a loft not accessible to the clients in care. The Facility is located at 461 Estrelita Dr. Vista CA. 92084. The facility phone number is (760) 295-4587 and it is operable.
Physical Plant: Indoor and outdoor passageways are free from obstructions. Pool was observed to meet statutory requirements and is inaccessible to residents in care. The Administrator stated there are no firearm/ammunition, or weapons, are stored on the premises. All window screens are clean and in good repair. Facility temperature was within the approved range regulations. Fire/smoke alarms and carbon monoxide detectors are operational. Fire extinguishers were inspected within the last 12 months and placed in prominent areas. Audible alarm system is in place. Residents' bedrooms are equipped with required furnishings, including but not limited to ample storage space, chair, lamp, night stand, and bed/mattresses. Resident bathrooms are located near their bedrooms and observed to be clean and sanitary. Hot water temperature at faucets for residents' use were measured within regulations. LPA Mixson observed There are night lights in the hallway. There are sufficient hygiene products for personal use, and a sufficient supply of clean linens. Facility maintains a two-day supply of perishable food items and a seven-day supply of non-perishable food items. All kitchen, food storage, and preparation areas are clean with appropriate utensils and equipment. Sample menu was reviewed.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 374604146
VISIT DATE: 03/06/2024
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 LPA Mixson reviewed staff and resident files and conducted staff and resident interviews. LPA Mixson reviewed previous CCL reports. There were no regulation violations observed during today’s visit.

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

SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2024
LIC809 (FAS) - (06/04)
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