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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604315
Report Date: 10/04/2022
Date Signed: 10/04/2022 05:26:22 PM


Document Has Been Signed on 10/04/2022 05:26 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



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: 5DATE:
10/04/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
03:59 PM
MET WITH:Administrator, Aaron LazarusTIME COMPLETED:
05:35 PM
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Licensing Program Analyst (LPA) Janira Arreola conducted an announced case management visit in order to increase the capacity per licensee request. LPA met with Administrator, Aaron Lazarus.

Licensee request for capacity increase approval of building from (6) to (8). Fire Clearance is approved for (3) bedridden clients approved by the Vista Fire Department on 07/13/2022. Facility sketch on file with designation of capacity for each room; licensee is advised that the noted designated capacity for each room is to remain in compliance as described on the facility sketch and each room capacity attachments. Rooms #4 and #5 are designated for bedridden resident. Resident bedrooms observed to be in sufficient compliance to grant capacity increase. LPA observed the Administrator has installed sprinkler system and appropriate fire alarms. Both bedrooms have a required door leading to the exterior of the facility. The physical plant is ready for increase in capacity.

LPA received Corporate board resolution during the time of the visit. LPA will submit file for capacity increase approval. The final approval of capacity increase is contingent upon LPM's final file review. Licensee will be notified by LPA once capacity increase has been approved by licensing. If capacity increase is approved, new license will follow in the mail after phone notification by LPA with Licensee. There are currently (5) residents in care as of today. .

An exit interview conducted and where this report was reviewed and provided to Administrator, Aaron Lazarus.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/04/2022
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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