374604154-10-12-2023-08-AS-DSEA-CWJUPF-20231012154529

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604154
Report Date: 10/12/2023
Date Signed: 10/12/2023 05:16:09 PM

Document Has Been Signed on 10/12/2023 05:16 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	PROVIDE SCH LLC		FACILITY NUMBER:	374604154
ADMINISTRATOR:	SALGADO, MARK		FACILITY TYPE:	735
ADDRESS:	7010 DELOS DR		TELEPHONE:	(619) 773-6043
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92139
CAPACITY: 4		CENSUS: 3	DATE:	10/12/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Mark Salgado, Licensee		TIME COMPLETED:	02:45 PM

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) Dawn Segura conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA identified herself and was granted entry by Rowena Bueno, Staff, to whom LPA disclosed the purpose of the visit. The licensee, Mark Salgado, was contacted via telephone and arrived a short time later. According to the facility’s license, the facility has a maximum capacity of four (4) clients, of which all must be ambulatory. During today’s inspection, there were a total of three (3) clients in care, one (1) of whom was present during the visit. This facility does not feature a secured perimeter or delayed egress doors. LPA, accompanied by licensee, 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 furnishings. Doors, windows, toilets, and showers 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 was 75 degrees F during the visit. Refrigerator and freezer temperatures were within regulatory range. LPA observed, via measurement with a thermometer device, that hot water temperature in bathroom used by clients was 107.8 degrees F. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in a locked closet. Confidential records were stored in locked areas. No pools or bodies of water were observed on the premises. Per the licensee, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: PROVIDE SCH LLC	FACILITY NUMBER: 374604154
	VISIT DATE: 10/12/2023

NARRATIVE

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were all working. Fire extinguisher was present. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA interviewed staff and client and reviewed staff and client records/files. LPA interviews did not raise any licensing concerns. Licensee also has current/active business liability insurance. Administrator’s certification has expired; however, the backup administrator's certification is current and up to date.

No deficiencies were cited during today's visit. An exit interview was conducted with Mark Salgado, 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: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023

LIC809 (FAS) - (06/04)

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