<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604427
Report Date: 05/30/2024
Date Signed: 05/30/2024 03:26:21 PM

Document Has Been Signed on 05/30/2024 03:26 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:SACRED HEART HOME CARE 2FACILITY NUMBER:
374604427
ADMINISTRATOR/
DIRECTOR:		IMSON, EMMAFACILITY TYPE:
735
ADDRESS:823 CAMELLIA STTELEPHONE:
(858) 722-5094
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY: 4CENSUS: 3DATE:
05/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Ludy Frogoso, CaregiverTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Jacqueline Shaw Ross and Licensing Program Manager (LPM) Tricia Danielson made an unannounced visit to conduct the required annual inspection. LPA was greeted at the door by Caregiver, Ludivina Frogoso and explained the purpose of the visit. Administrator, Emma Imson arrived shortly. LPA was informed the three (3) other clients reside at the home but were at day program. A tour of the facility was conducted inside and out. The facility is approved for four (4) Developmentally Disabled adults ages 18-59; all of whom must be ambulatory.
The facility is a one story 4 bedroom 2 bathroom home. There is also a bedroom designated for live-in staff. LPA and LPM observed clients bedroom furnishings to be in good repair with adequate lighting. Furniture throughout the house was observed to be in good condition. Clients have clean linen in good repair and sufficient hygiene products to meet their needs. All required postings are placed in a prominent area. Facility's Administrator certificate was noted to be active until 03/26/2025. Facility has multiple operating dual smoke alarms and carbon monoxide detector that meet statutory standards. Fire extinguishers were examined and determined to be in compliance. All inside and outside passageways are clear of obstructions. There are no pools or bodies of water observed. According to Administrator, no guns and/or ammunition are stored on the premises.
LPA observed the kitchen area to be clean and odor free with sufficient dishes and glassware. A two day supply of perishable, and a seven day supply of non-perishable, food items were observed. Hot water was measured at 116.0 degrees F. Temperature in the facility was 74 degrees. There is a locked storage area for medication. Chemicals and poisons are stored in a locked cabinet. (Continue on LIC809C)
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE: DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SACRED HEART HOME CARE 2
FACILITY NUMBER: 374604427
VISIT DATE: 05/30/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued from LIC809
Staff and client records were reviewed and a staff interview was conducted as well.
LPA and LPM verified P&I funds are kept separately from facility funds. Client medications were verified to be dispensed as prescribed.

No deficiencies were cited per Title 22, Division 6 of the California Code of Regulations at this time.

An exit interview was conducted and a copy of this report was provided to Caregiver Frogoso.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE:

DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2