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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604425
Report Date: 06/01/2022
Date Signed: 06/01/2022 04:21:28 PM


Document Has Been Signed on 06/01/2022 04:21 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:LA JOLLA CASA FIESTAFACILITY NUMBER:
374604425
ADMINISTRATOR:FERNANDEZ, JENNIFERFACILITY TYPE:
740
ADDRESS:5426 AVENIDA FIESTATELEPHONE:
(858) 775-6935
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY:6CENSUS: 6DATE:
06/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:House Manager, Tiffany LynchTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced Required 1 - Year inspection. The LPA was greeted by House Manager, Tiffany Lynch, identified himself, and discussed the purpose of the visit.

During today's inspection, the LPA observed the following: No pools or bodies of water were observed. Exterior and interior passageways were free from obstructions. Toxins, cleaning supplies, and chemicals were locked and inaccessible to residents at the time of the visit. Each resident had clean and sufficient bed linens, towels, and washcloths. All of the residents’ rooms were equipped with the required furnishings. Residents’ bathrooms were observed to be sanitary and operational. The facility was stocked with a 2-day supply of perishable and a 7-day supply of nonperishable food items. Medications were stored in a locked cabinet and were labeled and maintained in compliance with label instructions.

In accordance with the Department’s Infection Control program, the LPA provided technical assistance and observed and evaluated the facility's implementation of infection control practices. The LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff and visitors; a sign-in policy enacted for all visitors; signs posted at facility entrance with the facility’s visitor policy, and signs throughout the facility to promote hand hygiene, cough/sneeze etiquette and physical distancing; face coverings worn by staff; hand sanitizer/hand washing stations readily available; a designated visitation area; and emergency agencies’ contact information posted in a location visible to staff and resident. Based on observations, the facility is in compliance with and has implemented infection control practices. No deficiencies were observed during today's visit.

An exit interview was conducted with House Manager, Tiffany Lynch, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided to.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2022
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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