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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604333
Report Date: 07/26/2022
Date Signed: 07/26/2022 10:02:20 AM

Document Has Been Signed on 07/26/2022 10:02 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:BEYOND INTELLECTUAL ABILITIES, LLCFACILITY NUMBER:
374604333
ADMINISTRATOR:ACOSTA, CHRISTIANFACILITY TYPE:
735
ADDRESS:1762 PEMBER AVETELEPHONE:
(619) 519-2770
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY: 4CENSUS: 3DATE:
07/26/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Christian Acosta, LicenseeTIME COMPLETED:
10:10 AM
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Licensing Program Analyst (LPA) Carmen Lopez and County of San Diego Nurse Contractor, Elizar Perez with the HAI Program, conducted an on-site HAI assessment visit. LPA and team identified themselves and discussed the purpose of the visit with Licensee Christian Acosta.

The Department conducted an on-site visit to provide technical assistance and to evaluate the facility's mitigation plan on the COVID-19 protocols and procedures to include cleaning and disinfection, testing, isolation and quarantine, hand hygiene and screening protocols as well as the use of personal protective equipment (PPE). During today's visit, the team interviewed the Licensee and conducted a walk-though of the facility. A debriefing was conducted with the Licensee at the conclusion of the visit. During today's visit, no deficiencies were cited.

An exit interview was conducted with Licensee Christian Acosta to whom a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided at the conclusion of the visit. The signature below serves as confirmation of receipt of the documents.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2022
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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