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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604321
Report Date: 05/19/2022
Date Signed: 05/19/2022 10:15:04 AM

Document Has Been Signed on 05/19/2022 10:15 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:SANTA FAUSTINA ARFFACILITY NUMBER:
374604321
ADMINISTRATOR:BEALS, SUSANFACILITY TYPE:
735
ADDRESS:227 BAVARIA DRTELEPHONE:
(760) 806-9616
CITY:VISTASTATE: CAZIP CODE:
92083
CAPACITY: 6CENSUS: 6DATE:
05/19/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:Susan Beals, LicenseeTIME COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA) Javina George and the County of San Diego Nurse, Sandra Brackman, with the HAI Program, conducted an on-site visit. The team identified themselves and discussed the purpose of the visit with Licensee Susan Beals and Caregiver Arlene Escalona.

The Department and HAI Team conducted the on-site visit to provide technical assistance and to evaluate the facility's disinfection, screening protocols as well as the use of personal protective equipment. During today's visit, the HAI team discussed the proper use of EPA classified cleaners and disinfectants, and how to perform hand hygiene.

Licensee Susan and Caregiver Arlene were also provided training on how to properly don, doff, and dispose of PPE gear. A debriefing that included questions was conducted with Licensee Susan Beals and caregiver Arlene at the conclusion of the visit.

No deficiencies, were cited during today’s visit.

An exit interview was conducted, and a copy of this report was provided to Licensee Susan Beals.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 05/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2022
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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