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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604477
Report Date: 09/21/2021
Date Signed: 09/29/2021 03:06:34 PM

Document Has Been Signed on 09/29/2021 03:06 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:SCARLETT'S CAREFACILITY NUMBER:
374604477
ADMINISTRATOR:SORENSON, BRADLEYFACILITY TYPE:
735
ADDRESS:1024 NEPTUNE DRIVETELEPHONE:
(619) 634-1889
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 4CENSUS: 0DATE:
09/21/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:03 AM
MET WITH:Applicant, Bradley SorensonTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Elizabeth Hamilton, conducted an announced Pre-Licensing/Component III inspection at the facility. LPA was greeted at the front door by Applicant, Bradley Sorenson and granted entry after identifying herself. LPA Hamilton explained the purpose of the visit which was to evaluate Title 22 compliance for the initial application of initial licensure. The facility plans to serve four (4) developmentally disabled adults, ages 18-59; all of whom are ambulatory. The fire clearance was granted by Chula Vista Fire Department on August 24, 2021.

An inspection of the facility was conducted inside and out. The facility has three (3) client bedrooms and two (2) bathrooms for client use. Client bathrooms are equipped with a toilet, hand washing and bathing facilities which are sanitary and in operating condition. All lighting fixtures and facility windows were operable and in good condition. A light was present in the hallway leading to the restroom.

Indoor and outdoor passageways were free from obstructions. Fire extinguisher, smoke and carbon monoxide detectors were present and operational. LPA observed no pools or other bodies of water on the premises. Locked cabinets and storage areas were identified to store toxic substances and medication. Hazardous items were stored such that they were inaccessible to clients. Licensee reports there are no firearms or weapons stored at the facility. The fireplace is non-operational and is screened.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Elizabeth Hamilton
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SCARLETT'S CARE
FACILITY NUMBER: 374604477
VISIT DATE: 09/21/2021
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Client records are stored in a cabinet and made confidential. LPA observed facility accommodations including food service, dishes and food storage were observed as well as a first aid kit. Activities and sufficient space in which to conduct activities were present. Required CCLD postings were present. LPA discussed the ARF Component III with Applicant, Bradley Sorenson for continuing operational requirements, record keeping, reporting requirements and physical plant compliance. Applicant’s Administrator Certification is current through December 20, 2022.

Items reviewed during the visit were not in compliance with Title 22, Division 6, Chapter 8, of California Code of Regulations at this time. Therefore, another Pre-Licensing visit will be required and scheduled. This is to ensure compliance with the following: knives and sharp objects will be secured and inaccessible separate from cleaning supplies, confidential storage area for personnel records, a sufficient supply of linens and water temperature will be verified. An exit interview was conducted with Applicant, Sorenson. A copy of this report along with the licensee Appeal Rights (LIC 9058 01/16) was provided via email. A copy of this report and Applicant Rights (LIC 9058) were provided to the Applicant via electronic mail. An electronic mail read receipt confirmation was requested to be sent to LPA upon receipt of the documents.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Elizabeth Hamilton
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2021
LIC809 (FAS) - (06/04)
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