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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604551
Report Date: 11/01/2023
Date Signed: 11/01/2023 10:59:29 AM

Document Has Been Signed on 11/01/2023 10:59 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
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:
11/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:48 AM
MET WITH:ADMINISTRATOR, LEEDA DOSTTIME COMPLETED:
11:08 AM
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On November 01, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived to the facility unannounced in order to conduct the required annual inspection and met with the Administrator, Leeda. The LPA introduced herself, and stated the purpose of the visit.

LPA Mixson toured the facility along with the Administrator, and inspected the facility inside and outside, and there were no obstructions to the indoor or outdoor passageways at the time of this visit. The facility is a single story home, located at 822 East Washington Street, Escondido. Physical Plant: The Administrator stated the facility lain-line phone will be updated as soon as residents are received. The Administrators number is (858) 348- 7247, and is operable. The LPA observed the resident bedrooms, and they are equipped with required furniture as per Title 22. The LPA inspected the facility bathrooms, and the hot water temperature was tested previously during the pre-licensing and within regulations. Bathrooms were clean and appliances were operating appropriately at the time of this visit. The facility is equipped with operating smoke detectors, carbon monoxide alarms, and fire extinguisher. The LPA observed required postings such as, "If you See Something, Say Something" and the "Personal Rights" postings were posted in a common area. The cleaning supplies and sharp items were kept locked and inaccessible to the residents. There was a designated storage space for the resident and staff files. Medications: The location were the medications will be stored once the facility receives residents, was reviewed, it was locked and inaccessible to future residents. The overall facility is clean, the furniture is in good condition. The facility air conditioning and other appliances were operable currently at the time of this visit. Food Service: There are currently no staff and/or residents due to being newly licensed, the facility will provide the required food items once there are residents. Dishes and utensils were in sufficient supply and stored properly. Care & Supervision: Currently there are no staff and no residents due to newly licensed facility. Records Review: The LPA reviewed zero resident files, and zero staff files. There were no Title 22, Division 6 Regulation violations observed and/or cited during todays visit.
An exit interview was conducted and a copy of this report was given to the Administrator, Leeda.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2023
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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