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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604477
Report Date: 10/11/2022
Date Signed: 10/11/2022 05:18:41 PM

Document Has Been Signed on 10/11/2022 05:18 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:
10/11/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:House Manager, Reynaldo PuaTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA), Marisela Garcia-Centeno, conducted a case management visit to provide guidance on cleaning and disinfection protocols according to their infection control requirements. LPA was granted entry into the facility by House Manager, Reynaldo Pua, to whom LPA identified herself and disclosed the purpose of the visit. Administrator, Bradley Sorenson joined the visit via telephone a short time after.

During a required annual inspection, the LPA observed the facility kitchen, dinning area and client bathrooms were not being clean according to the infection control guidelines. LPA reviewed the guidelines and counseled on the cleaning products that meet EPA requirements with facility staff. In addition, LPA discussed the addendum requirement for Monkeypox with Administrator, Sorenson as well as reporting requirements to CCL, San Diego Regional Center and responsible parties. Administrator, will be submitting the addendum for Monkeypox to CCL prior to admitting their first client.

An exit interview was conducted with House Manager, Pua, to whom a copy of the report and Licensee/Appeal Rights (LIC 9058 01/16) were provided at the conclusion of the visit
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2022
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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