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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604315
Report Date: 07/13/2020
Date Signed: 06/28/2021 04:30:05 PM

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:CARING HEARTS COTTAGEFACILITY NUMBER:
374604315
ADMINISTRATOR:LAZARUS, AARONFACILITY TYPE:
740
ADDRESS:682 VALE VIEW DRTELEPHONE:
(619) 246-0731
CITY:VISTASTATE: CAZIP CODE:
92081
CAPACITY:6CENSUS: 0DATE:
07/13/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Aaron Lazarus, LicenseeTIME COMPLETED:
05:30 PM
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Licensing Program Analysts (LPAs) Carmen Lopez and Dawn Segura conducted a Pre-Licensing Virtual Visit, via video conference, due to COVID-19, to observe the facility for compliance with Title 22, Division 6, of California Code of Regulations and Health and Safety Code. The LPAs were joined on the call by Aaron Lazarus, Licensee.

The LPAs and facility representative toured the physical plant, and LPAs observed the following: resident accommodations, including furnishings, linens, and personal hygiene items; water temperature in a resident bathroom measured at 107 degrees F; facility records will be stored in a locked cabinet located at the back of the kitchen; medications will be stored in a locked cabinet; food service, including dishes and food storage were observed; toxic substances will be stored in the basement, to which access will be locked; a first aid kit is stored in the facility; activities and sufficient space in which to conduct activities are present; a fire extinguisher is present; smoke and carbon monoxide detectors are present and operable; required facility postings are present and visible in a common area of the facility. According to the administrator, there are no guns, weapons, or ammunition stored on the facility property. No swimming pool or body of water was observed on the facility property. Component III was conducted and completed during today’s visit.

Items reviewed during the visit are in compliance with Title 22, Division 6, Chapter 8, of California Code of Regulations. The administrator was advised that the application is pending management final review and approval. A copy of this report and Applicant Rights (LIC 9058) were provided to the administrator via electronic mail. An electronic mail read receipt confirmation was requested to be sent to LPAs upon receipt of the documents.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2020
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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