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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604282
Report Date: 06/15/2023
Date Signed: 06/15/2023 01:58:39 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/15/2023 01:58 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
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:ABIGAIL'S HOMES IIIFACILITY NUMBER:
374604282
ADMINISTRATOR:GONZALEZ, BRENDA ABIGAILFACILITY TYPE:
735
ADDRESS:2505 ARCADIA AVETELEPHONE:
(619) 439-7791
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY: 4CENSUS: 2DATE:
06/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Raquel GarciaTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Riza Alvarez conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Administrator Garcia.

According to the facility’s license, the facility has a maximum capacity of four (4) ambulatory clients, all of whom must be ambulatory. During today’s inspection, there was a total of two (2) clients in care, both are out in day program. Per medical records, both clients are ambulatory. This facility does not feature a secured perimeter or delayed egress doors.

LPA, accompanied byAdministrator, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was 71 F. Hot water temperature at taps accessible to clients were all compliant: Kitchen sink was 111.1 F, and Bathroom sink was 112.3 F.

Refrigerator temperatures were compliant at 39 F and freezer temperatures were 0 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 locked areas.


[CONTINUED ON LIC 809-C]
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Riza Gloria Alvarez
LICENSING EVALUATOR SIGNATURE: DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/15/2023
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
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: ABIGAIL'S HOMES III
FACILITY NUMBER: 374604282
VISIT DATE: 06/15/2023
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[CONTINUED FROM LIC 809]

No pools or bodies of water were observed on the premises. Per the licensee's staff, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher was serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA interviewed Administrator.. The interviews did not raise any significant licensing concerns. LPA reviewed multiple staff and client records/files. The reviewed files contained required documents. Confidential records were stored in locked areas. Licensee's staff also presented proof of current/active business liability insurance and surety bond.

No deficiencies were observed or cited during today's annual inspection.



An exit interview was conducted with Administrator Garcia, 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: John Rante
LICENSING EVALUATOR NAME: Riza Gloria Alvarez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2023
LIC809 (FAS) - (06/04)
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