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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604327
Report Date: 06/24/2024
Date Signed: 06/24/2024 01:49:13 PM

Document Has Been Signed on 06/24/2024 01:49 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:ALEJANDRA'S HOME #1FACILITY NUMBER:
374604327
ADMINISTRATOR/
DIRECTOR:
BASURTO, ALEJANDRAFACILITY TYPE:
735
ADDRESS:1374 CARPINTERIA STREETTELEPHONE:
(619) 616-6685
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY: 6CENSUS: 5DATE:
06/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Licensee Alejandra BasurtoTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Required Annual Inspection. The LPA introduced himself and disclosed the purpose of the visit with Licensee Alejandra Basurto.

The facility was licensed for a capacity of six (6) ambulatory clients, with an age range of 18 to 59. At the time of the visit the facility had a census of five (5).

During today's visit, the LPA toured the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction. Resident bedrooms contained the required furnishings There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. There were no toxic chemicals/poisons accessible to clients. Medications were labeled, and stored in a locked area.

No pools, nor bodies of water were observed on the premises. Per staff, no firearms, nor ammunition were kept at the facility. Smoke detector, fire extinguisher(s), a first aid kit, and required licensing postings were observed in visible area of the facility.



The LPA interviewed staff and reviewed multiple staff and client records/files. The files which LPA reviewed contained required documents.

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

An exit interview was conducted with Licensee Alejandra Basurto, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058), were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2024
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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