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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604476
Report Date: 01/23/2023
Date Signed: 01/23/2023 11:18:00 AM

Document Has Been Signed on 01/23/2023 11:18 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:NEW VISION HOMES ARFFACILITY NUMBER:
374604476
ADMINISTRATOR:BELTRAN, YESENIAFACILITY TYPE:
735
ADDRESS:859 LACEBARK STTELEPHONE:
(442) 515-3083
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY: 4CENSUS: 3DATE:
01/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator, Yesenia BeltraTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Janira Arreola, made an unannounced visit on 01/23/2023 at 10:00 a.m. in order to conduct an annual visit with a focus on infection control. LPA met with Administrator, Yesenia Beltra, who was informed of the purpose of the visit. At the time of the visit there was (1) staff and (2) residents present.

LPA proceed to conduct a walk through of the facility's interior and exterior. LPA observed there was a central entry point where screenings are conducted for facility visits. Daily temperature checks are conducted for staff, residents, and visitors. LPA observed COVID-19 postings throughout the facility. The facility has a 30-day supply of PPE equipment that is readily accessible to staff. LPA observed the resident bedrooms that would be used as isolation rooms. The resident bathrooms were observed to be clean and have the appropriate hand hygiene supplies such a soap, running water and paper towels.

The facility has a cleaning plan in place to disinfect and clean the high touch surfaces of the facility and the isolation rooms. The staff have leave in case of contact or testing positive for COVID-19, and there is a plan of care in place to attend to those residents that would be in the isolation rooms.

Technical Advisory notes were documented for the staff to get N95 fit tested.

No deficiencies were cited at the time of the visit.

An exit interview was conducted where this report was reviewed and provided to Administrator, Yesenia Beltran.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 01/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/23/2023
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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