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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604187
Report Date: 09/30/2021
Date Signed: 10/11/2021 01:20:36 PM

Document Has Been Signed on 10/11/2021 01:20 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:UNEXPECTED POSSIBILITIES, INCFACILITY NUMBER:
374604187
ADMINISTRATOR:TALIA, LORETTAFACILITY TYPE:
735
ADDRESS:807 BENNY WAYTELEPHONE:
(619) 277-3520
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY: 4CENSUS: 4DATE:
09/30/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Staff Roosevelt EdwardsTIME COMPLETED:
02:05 PM
NARRATIVE
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Licensing Program Analyst (LPA) Ramon Serrano and Licensing Program Manager (LPM) John Rante, conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPA and LPM met with Staff Roosevelt Edwards and we discussed the purpose of the visit. All staff present have a current criminal record clearance. The Licensee was contacted via telephone to discuss infection control procedures.

LPA and LPM conducted a tour of the facility, both inside and outside and observed the client in care. In accordance with the Department’s Infection Control, LPA and LPM provided technical assistance, evaluated, and observed the facility's implementation of their mitigation plan to include disinfection, testing surveillance, and screening protocols as well as the use of personal protective equipment.

No deficiencies were cited or observed on this date.

The Licensee will be provided a copy of her appeal rights (LIC9058 01/16). An exit interview was conducted and a copy of this report will be emailed to the Licensee with an electronic read receipt as confirmation of documents.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2021
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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