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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604574
Report Date: 04/12/2022
Date Signed: 04/12/2022 05:32:11 PM

Document Has Been Signed on 04/12/2022 05:32 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:LIVE AND CAREFACILITY NUMBER:
374604574
ADMINISTRATOR:TURNER, ANGIEFACILITY TYPE:
735
ADDRESS:861 REBECCA DRIVETELEPHONE:
(619) 588-6372
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY: 4CENSUS: 0DATE:
04/12/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Angie Turner, ApplicantTIME COMPLETED:
12:05 PM
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Licensing Program Analyst (LPA) Dawn Segura conducted an announced Pre-Licensing visit. LPA was joined by Applicant, Angie Turner, and granted entry into the facility. The purpose of the visit was to inspect the facility to ensure that the facility is in compliance with California Code of Regulations, Title 22, Division 6. The fire inspection was completed on March 3, 2022, and the facility was approved for 4 ambulatory clients.

During today's visit, LPA, accompanied by applicant, toured the facility inside and outside and inspected every room. The facility was found to be in good repair with no pathway obstructions. Clients' bedrooms were observed to be clean, some furnishings were present, and additional required furnishings will be transferred from the facility's current location. Facility temperature was 66 degrees F during the visit. Toilets were found to be in working order. Hot water temperature in client bathroom measured at 133 degrees F. Hazardous and/or toxic chemicals will be stored and secured in locked cabinets that are inaccessible to clients. Locked cabinets will be used for storage of medications and client and staff records. There were first aid kits present in the facility. The facility has sufficient space in which to conduct activities. Smoke and carbon monoxide detectors were present and were recently inspected by the local fire authority. No pools or bodies of water were observed near or on the premises. According to the applicant, no firearms and/or ammunition were present or will be stored in the facility. Sufficient and appropriate storage was present to store perishable and non-perishable food items. Required postings were present and posted in a visible area of the facility. As the licensee is only seeking to change the facility’s location, Component III was previously conducted and was waived during today’s visit.

The facility’s hot water temperature for client use was not in compliance with Title 22, Division 6, Chapter 8 of California Code of Regulations during today’s visit, and applicant has not passed the pre-licensing inspection. Applicant was advised that a follow-up visit will be necessary to ensure compliance. This report was discussed with the applicant, and a copy of the report and Applicant Rights (LIC 9058) will be provided, via email, following the visit.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE: DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/12/2022
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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