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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604187
Report Date: 09/16/2022
Date Signed: 09/16/2022 02:37:46 PM

Document Has Been Signed on 09/16/2022 02:37 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:
09/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Shevell Sterling, Administrator, and Roosevelt Edwards, Facility ManagerTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Carmen Lopez made an unannounced visit to the facility to conduct an annual required licensing inspection. LPA identified herself and was granted entry by Roosevelt Edwards, Facility Manager. Administrator Shevell Sterling later arrived and joined the visit. LPA met with Administrator Sterling and Facility Manager Edwards and discussed the purpose of today’s visit.

A tour of the facility was conducted inside and out. LPA accompanied by Administrator Sterling and Facility Manager Edwards conducted a general overall inspection, with specific focus on infection control protocols.

During today's inspection LPA observations include the following: Symptom screening procedures for staff, residents and visitors; posted signs regarding visitor policy, promoting hand washing/hand hygiene practices, cough and sneeze etiquette and other infection control procedures; testing plan and procedures for staff and clients; plans for containing infections; PPE supplies procedures and training; and disinfection procedures. LPA provided updated guidance of current PIN for Resident Cohorting, Isolation and Quarantine, Staffing and Use of Personal Protective Equipment Based on Resident Coronavirus Disease 2019 (COVID-19) Status; and face covering guidance was provided.

Based on today’s inspection, no deficiencies were observed. An exit interview was conducted with Administrator Sterling and Facility Manager Edwards. A copy of this report, along with the Licensee Rights was provided to Administrator Serling and Facility Manager Edwards at the conclusion of the visit. The signature below serves as confirmation of receipt of these documents.

LPA requested for Administrator Sterling or Facility Manager Edwards to submit a current Designation of Administrative Responsibility LIC 308, Personnel Report LIC 500 and Emergency Disaster Plan LIC 610-D to the licensing office within 10 business days. Forms available at www.ccld.ca.gov.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 09/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/16/2022
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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