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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604250
Report Date: 10/25/2024
Date Signed: 10/25/2024 11:25:39 AM

Document Has Been Signed on 10/25/2024 11:25 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:BUILDING INDEPENDENCE 1FACILITY NUMBER:
374604250
ADMINISTRATOR/
DIRECTOR:		SANCHEZ, JAQUELINEFACILITY TYPE:
735
ADDRESS:1965 PIZARRO LANETELEPHONE:
(858) 780-6695
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY: 4CENSUS: 4DATE:
10/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Licensee, Jaqueline SanchezTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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On 10/25/2024, Licensing Program Analyst (LPA), Janette Romero made an unannounced visit to conduct a required annual inspection. LPA was greeted and granted entry by Caregiver, David Cabrera who was informed of the purpose of the visit. The facility has a fire clearance for four (4) ambulatory adults ages 18 through 59. Licensees Esteban and Jaqueline Sanchez arrived during the visit.

During today's visit there was one (1) client and one (1) care staff present. LPA toured the facility with Caregiver Cabrera and observed the facility is made up of a two-story home with three (3) client bedrooms, two (2) bathrooms, two (2) living rooms, a kitchen, dining room, and attached garage. There are no bodies of water on the premises and indoor and outdoor passageways were free of obstruction. LPA toured the kitchen and observed the facility has more than a two-day supply of perishable foods and seven-day supply of non-perishable food items, which are stored in a safe and healthful manner. LPA observed knives, scissors and sharp instruments secured in a locked safe, stored on top of the kitchen counter. Caregiver Cabrera tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed all alarms to be operational. LPA observed two (2) charged fire extinguishers mounted in the facility. LPA observed cleaning solutions and disinfectants secured in a storage closet inside the locked laundry room. LPA observed backpacks filled with emergency supplies available for the clients in care. Medications are secured in a locked cabinet next to the downstairs the restroom. LPA reviewed the Record Of Client's/Resident's Safeguarded Cash Resources (LIC405) for the current clients while Caregiver Cabrera counted their physical monies and no discrepancies were discovered. LPA reviewed random client files and noted they had updated Individual Program Plans and signed admission agreements.

During today's visit, LPA did not observe any issues or concerns. An exit interview was conducted and a copy of this report was reviewed and provided to Licensees.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2024
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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