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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604477
Report Date: 11/17/2023
Date Signed: 11/21/2023 08:34:14 AM

Document Has Been Signed on 11/21/2023 08:34 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:SCARLETT'S CAREFACILITY NUMBER:
374604477
ADMINISTRATOR:SORENSON, BRADLEYFACILITY TYPE:
735
ADDRESS:1024 NEPTUNE DRIVETELEPHONE:
(619) 500-5339
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 4CENSUS: 2DATE:
11/17/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Administrator, Yuri VegaTIME COMPLETED:
04:50 PM
NARRATIVE
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Licensing Program Analyst (LPA), Natasha Persaud conducted a Case Management -Deficiency visit. LPA was greeted and allowed entry into the facility and met with Administrator, Yuri Vega.

On 11/15/23, LPA observed Client #1(C1) sitting in their room in a large chair propped up against their bedroom door, which did not appear unusual. C1 also has another door to access their bedroom that leads from a bathroom from a common area. There didn’t seem to be any concerns as C1 chose to sit in that chair instead of the common area. Today, 11/17/23 LPA observed the large chair blocking the bedroom entrance again and the door was also locked from the inside. Staff interviews revealed the large chair was blocking the door and locked for C1’s safety. C1 is unable to unlock the door due to their mental capacity. There’s another client, Client #2 (C2) who will run up to C1’s bedroom door and try to enter. C2 has a known behavior of biting and a medical condition that affects their auditory and sensory abilities. When C2 hears C1 making noises in their room, it can trigger C2 to want to attack C1 by biting them. Therefore, staff thought if they blocked the door and locked it would allow for safety of C1. Staff were made aware they cannot block the door or lock it. The facility staff are required to meet the needs of clients and ensure compatibility. The licensee was aware of C2’s biting behaviors prior to accepting C2 into care. The facility staff are capable of supervising the clients. However, the licensee did not ensure staff are equipped to handle C2’s behaviors, as C1’s personal rights were violated, while trying to protect C1. The facility has rectified the situation by relocating C1 to another bedroom away from C2. Also, the facility is in the process of hiring additional staff equipped to handle the behaviors in the home.

Based on observations and interviews a deficiency is being issued today for barricading and locking the door, instead of ensuring staff are equipped with handling certain behaviors accepted by the facility. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Administrator, Yuri Vega whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Client #1 and Client #2].

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2023
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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Document Has Been Signed on 11/21/2023 08:34 AM - It Cannot Be Edited


Created By: Natasha Persaud On 11/17/2023 at 04:05 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SCARLETT'S CARE
FACILITY NUMBER: 374604477

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/17/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/15/2023
Section Cited
CCR
80072(a)(2)

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Personal Rights. Except for children’s residential facilities, each client
shall have personal rights which include, but are not limited to, the following: To be accorded safe, healthful and comfortable accommodations, furnishings, and equipment to meet his/her needs.
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Administrator stated they are in the process of hiring more experienced staff, they relocated C1 to a room further from the other client. In addition, the administrator stated staff will attend Personal Rights training to include addressing client behaviors to the
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This requirement is not met as evidenced by:
Based on observations and interviews, the licensee did not ensure 1 out of 2 clients in care [C1] was provided safe accommodations which posed a potential health and safety risk.
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specific client's individual needs.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lizzette Tellez
LICENSING EVALUATOR NAME:Natasha Persaud
LICENSING EVALUATOR SIGNATURE:
DATE: 11/17/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2023


LIC809 (FAS) - (06/04)
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