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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604551
Report Date: 09/08/2022
Date Signed: 09/08/2022 03:36:00 PM

Document Has Been Signed on 09/08/2022 03:36 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:GARDENS ARFFACILITY NUMBER:
374604551
ADMINISTRATOR:DOST, LEEDAFACILITY TYPE:
735
ADDRESS:822 E WASHINGTON AVETELEPHONE:
(858) 348-7245
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY: 6CENSUS: 0DATE:
09/08/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Licensee, Leeda DostTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Janira Arreola conducted an announced visit for the purpose of a pre-licensing inspection for an inital application. LPA met and was granted entry by Licensee, Leeda Dost who was informed of the purpose of the visit. LPA took a tour of the interior and exterior of the home. The home will be licensed for a total capacity of (6) residents, ages 18 to 59. LPA observed Fire Clearance dated (7/25/2022) was approved for 6 Ambulatory residents.

LPA was informed that no firearms or ammunition will be kept at the facility. There are also no bodies of water, such as pools at the facility. There is a shared pool in the community that is locked and gated. LPA observed the home as follows: The home is a single story 5 bedroom and 2 bathroom with an attached garage. Bedrooms 1, 2, 3, are to be used for residents and bedrooms 4 and 5 are not assigned a use. All 5 bedrooms have a night stand, lamp, bed, chair, and closet space. The facility has (2) working Carbon Monoxide. LPA observed locked closet in hallway where medications will be kept, and locked areas were cleaning supplies and sharp objects will be kept. LPA observed enough personal hygiene supplies including deodorant, shampoo, and body wash. The dining area has the needed 6 chairs, and the outdoor seating area. LPA tested the hot water temperature which was 107 degree Fahrenheit. LPA observed a sufficient 7-day supply of perishable foods, and enough plates, cups, pots, pans and silverware for 6 residents. LPA reviewed covid positings,, administrators certificate, emergency and disaster plan and background clearance.

LPA recommended Licensee to obtain another chair for (6) chairs in the outdoor area. LPA also recommended Licensee to obtain the necessary 2-day perishable food supply when receiving clients in care.

LPA observed the smoke alarms chirping during the visit. Licensee will replace batteries in smoke alarms and send proof of purchase and installment to LPA in order to be approved for licensure.

An exit interview was conducted where this report was reviewed and provided to Licensee Leeda Dost.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 09/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2022
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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