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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604580
Report Date: 11/04/2022
Date Signed: 11/09/2022 09:54:22 PM

Document Has Been Signed on 11/09/2022 09:54 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:NATURE'S RESIDENCEFACILITY NUMBER:
374604580
ADMINISTRATOR:ANDRADE, VICTOR JOSE RFACILITY TYPE:
735
ADDRESS:8554 S SLOPE DRIVETELEPHONE:
(619) 947-4870
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY: 3CENSUS: 0DATE:
11/04/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Applicant, Victor AndradeTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA), Debbie Correia, conducted an announced Pre-licensing Inspection. LPA met with applicant Andrade, LPA Correia identified herself, was allowed entry into the facility and stated the purpose of the inspection. Facility’s Fire Clearance was granted on October 4th 2022 for three (3) developmentally disabled clients, ages 18-59, all of whom must be ambulatory.

LPA was accompanied by Applicant Andrade during a tour of the facility, which was conducted inside and out. Facility has one or more operating smoke alarms and carbon monoxide detector that meet statutory standards. Facility has no bodies of water on the property. LPA observed a seven-day supply of non-perishable food items. Clients have clean linen in good repair and a sufficient supply of extra linens. Client bathrooms were equipped with a toilet, sink, and shower in operating and sanitary conditions. Facility is equipped with a locked storage area for medication and toxins. Facility has activities planned for clients, a common area, and large outdoor area including a shaded area for client activities.

In accordance with the Department’s Infection Control, LPA provided technical assistance, evaluated, and observed the facility's plan for implementation of the infection control plan to include disinfection, testing surveillance, and screening protocols for universal entrance, as well as the use of personal protective equipment.

Based on today’s inspection, facility is recommended for Licensure pending corrective plumbing issue regarding water temperature. An exit interview was conducted and a copy of this report and Licensee/Appeals Rights (9058 01/16) were left with Applicant Andrade, whose signature on this form confirms receipt of these documents.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE: DATE: 11/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/04/2022
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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