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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604477
Report Date: 10/01/2021
Date Signed: 10/01/2021 01:14:00 PM

Document Has Been Signed on 10/01/2021 01:14 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:
10/01/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:59 AM
MET WITH:Applicant, Bradley SorensonTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted a follow-up announced Pre-Licensing inspection at the facility. The initial Pre-Licensing visit was conducted on September 21, 2021, which included the Component III. 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.

LPA Hamilton observed the areas of correction to include; knives and sharp objects were secured and inaccessible separate from cleaning supplies, a confidential storage area for personnel records, a sufficient supply of linens and water temperature in bathroom #1 measured 109.2 and bathroom #2 measured 111.7 degrees Fahrenheit.

Items reviewed during the visit were in compliance with Title 22, Division 6, Chapter 8, of California Code of Regulations. The Applicant was advised that the application is pending management final review and approval. A copy of this report and Appeal 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: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2021
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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