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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604487
Report Date: 11/22/2025
Date Signed: 11/22/2025 09:52:55 PM

Document Has Been Signed on 11/22/2025 09:52 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:SPARKS ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
374604487
ADMINISTRATOR/
DIRECTOR:		SPARKS, ELSIEFACILITY TYPE:
735
ADDRESS:1973 LIEDER DR.TELEPHONE:
(619) 869-1856
CITY:SAN DIEGOSTATE: CAZIP CODE:
92154
CAPACITY: 4CENSUS: 4DATE:
11/22/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
06:30 PM
MET WITH:Licensee, Elsie SparksTIME VISIT/
INSPECTION COMPLETED:
08:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted a Case Management visit to cite a deficiency disclosed during an annual visit. LPA met with Licensee, Elsie Sparks and discussed the details of the violation.

During staff interviews conducted during today's visit it was disclosed that on August 28, 2025 there was one AWOL incident that occurred at the facility involving one client that was not reported to CCL as required. A client AWOL and wondered to a neighbor's home, the neighbor called law enforcement and emergency personnel transported client to hospital. No injuries were reported, client was discharged to the facility the same day..

Pursuant to the California Code of Regulations, Title 22, Division 6, deficiency is being cited on the attached LIC809D. A plan of correction plan was developed with Licensee, Elsie Sparks.

An exit interview was conducted with Licensee, Sparks to whom a copy of this report, LIC809D Deficiency Report , along with Licensee/Appeal Rights (LIC9058 03/22), were provided.
NAME OF LICENSING PROGRAM MANAGER: Sabel Martinez
NAME OF LICENSING PROGRAM ANALYST: Marisela Garcia-Centeno
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 11/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 11/22/2025 09:52 PM - It Cannot Be Edited


Created By: Marisela Garcia-Centeno On 11/22/2025 at 07:56 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: SPARKS ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 374604487

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/22/2025
Section Cited
CCR
81061(b)(E)

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81061(b)(E) REPORTING REQUIREMENTS
Upon the occurrence, during the operation of the facility, of any of the events specified in …….a written report containing the information specified … any unusual incident or client absence which threatens the physical or emotional health or safety of any client. This requirement was not met as evidence by:
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Licensee agreed to submit the incident reports for August 28, 2025 as required by Title 22 regulations. In addition, Licensee, Sparks agreed to conduct in service training for all staff on reporting requirements by an independent provider.
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Based on staff interviews the licensee did not ensure that all incidents were reported to CCL as required. This posed a potential health and safety risk to 1 of 4 clients in care.
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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.
Sabel Martinez
NAME OF LICENSING PROGRAM MANAGER:
Marisela Garcia-Centeno
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 11/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2025


LIC809 (FAS) - (06/04)
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