374604486-12-7-2023-08-AS-CLOZ-CYATW4-20231207140454

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604486
Report Date: 12/07/2023
Date Signed: 12/07/2023 02:05:40 PM

Document Has Been Signed on 12/07/2023 02:05 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	SWEET ANGELS BOARD & CARE		FACILITY NUMBER:	374604486
ADMINISTRATOR:	SANTELLA, JOCELYN		FACILITY TYPE:	735
ADDRESS:	7271 BROOKHAVEN RD		TELEPHONE:	(619) 770-0394
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92114
CAPACITY: 4		CENSUS: 4	DATE:	12/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Jocelyn Santella, Licensee		TIME COMPLETED:	02:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required Annual Inspection. The facility file was reviewed prior to the visit. LPA Lopez identified herself, was granted entry by Licensee Jocelyn Santella. LPA discussed the purpose of the visit with Licensee Santella. According to the facility’s license, there may be a maximum of four (4) clients all of whom may be ambulatory two (2) of whom may be non-ambulatory at any given time at the facility site. During today’s inspection, the facility’s current census is 4 clients living at the facility. There were no clients present at the facility site during the inspection. Clients later arrived at the end of the inspection. LPA, accompanied by Licensee Santella, toured the interior and exterior areas 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. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and activities. The facility’s ambient internal temperature was comfortable and compliant, at 70 degrees Fahrenheit (F). Hot water temperature at taps accessible to clients became compliant while at the facility: Kitchen sink was 125 F; sink in restroom #1 delivered hot water at 129.6 F and became compliant at 124 F; sink in restroom #2 delivered hot water at 131.9 F and became compliant at 125 F. There was at least 2 days of perishable food, and at least 7 days non-perishable food present. Cooking/dining equipment and utensils were present, and all safely stored. There were no toxic chemicals/poisons accessible to clients. Medications were properly labeled, as required, and stored in locked areas. LPA inspected the medication room and found that medications were properly labeled and stored in a locked cabinet. The facility maintained medication logs which LPA reviewed. [CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

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: SWEET ANGELS BOARD & CARE	FACILITY NUMBER: 374604486
	VISIT DATE: 12/07/2023

NARRATIVE

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[CONTINUED FROM LIC 809]

No pools or bodies of water on the premises. Per licensee, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present (04) and serviced within the last 12 months. First aid kit(s) were complete and readily accessible.

LPA reviewed staff and client records. LPA was able to interview 1 client during the inspection. During today’s visit one staff person was on the premise who was interviewed. LPA interviews did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in a locked area. Required licensing postings were observed in a visible area of the facility.

There was a deficiency observed, cited, and cleared during today's annual inspection. The citation can be reviewed and located on the LIC809-D page of this report.

An exit interview was conducted with Licensee Jocelyn Santella to whom a copy of this report along with the Licensee/Appeal Rights (LIC9058 03/22) were provided to at the conclusion of the visit. The signature below confirms the documents were received.

LPA requested Licensee Santella to submit a current Designation of Administrative Responsibility LIC 308, Personnel Report LIC 500, and Emergency Disaster Plan LIC 610-D, to the licensing office within 10 business days. An updated Residential Infection Control Plan LIC 9282 (6/23) has been submitted to the San Diego Regional Office. Forms are available at www.ccld.ca.gov.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 12/07/2023 02:05 PM - It Cannot Be Edited

Created By: Carmen Lopez On 12/07/2023 at 01:16 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: SWEET ANGELS BOARD & CARE	FACILITY NUMBER: 374604486
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/07/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80088(e)(2)

Fixtures, Furniture, Equipment, and Supplies

(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (2) Taps delivering water at 125 degrees F (51.6 degrees C) or above shall be prominently identified by warning signs. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above in 2 out of 3 faucets hot water which posed a potential safety risk to 4 of persons in care.
	POC Due Date: 12/07/2023
	Plan of Correction
1 2 3 4	Hot water was lowered and the temperatures reduced to the allowable temperature during LPA's visit.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Denise Powell

LICENSING EVALUATOR NAME:

Carmen Lopez

LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC809 (FAS) - (06/04)

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