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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604477
Report Date: 10/24/2023
Date Signed: 10/24/2023 11:44:17 AM

Document Has Been Signed on 10/24/2023 11:44 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
SAN DIEGO RO, 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: 3DATE:
10/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Licensee Bradley Sorenson and Administrator Yuri VegaTIME COMPLETED:
11:50 AM
NARRATIVE
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Required Annual Inspection Visit. The facility file was reviewed prior to the visit. The LPA identified himself and disclosed the purpose of the visit to Administrator Yuri Vega. Licensee Bradley Sorenson arrived during the visit.

The facility was licensed for a capacity of four (4) ambulatory residents. The census for today's date was three (3). All clients were off site during the visit.


The LPA, accompanied by the administrator, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Personal Protective Equipment was present. The facility had sufficient space to facilitate dining, laundry, visitation, meetings, and client activities.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present. There were no toxic chemicals/poisons accessible to clients. Medications were labeled, as required, and stored in locked areas.



No pools or bodies of water were observed in the premises. Per administrator, no firearms nor ammunition were kept at the facility. Required licensing postings were observed in visible areas of the facility.

The LPA interviewed the administrator and reviewed staff and client records. At least two (2) staff files did not have a 1st aid certificate. This deficiency was cited in accordance with California Code of Regulations, Title 22, on an LIC 809D.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SCARLETT'S CARE
FACILITY NUMBER: 374604477
VISIT DATE: 10/24/2023
NARRATIVE
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An exit interview was conducted with Administrator Vega, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058), were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2023
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/24/2023 11:44 AM - It Cannot Be Edited


Created By: Sabel Martinez On 10/24/2023 at 11:19 AM
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: 10/24/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80075(f)
80075 (f)
Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on review records and interview, the licensee did not comply with the section cited above in 2 staff, which posed a potential health, safety or personal rights risk to 3 of 3 persons in care.
POC Due Date: 11/17/2023
Plan of Correction
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Administrator agreed to train all staff in First aid, by 11/17/23 and submit proof of training to the LPA.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Sabel Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2023


LIC809 (FAS) - (06/04)
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