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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604596
Report Date: 11/17/2022
Date Signed: 11/17/2022 02:24:44 PM

Document Has Been Signed on 11/17/2022 02:24 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:TRITON HOMEFACILITY NUMBER:
374604596
ADMINISTRATOR:CASTRO, KRYSTALFACILITY TYPE:
735
ADDRESS:1357 TRITON AVENUETELEPHONE:
(619) 206-2005
CITY:SAN DIEGOSTATE: CAZIP CODE:
92154
CAPACITY: 4CENSUS: 0DATE:
11/17/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Owner, Krystal CastroTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA), Marisela Garcia-Centeno performed an announced visit to conduct a Prelicensing Inspection to observe the facility for compliance with Title 22, Division 6, of California Code of Regulations and Health & Safety Code. LPA met with Property Owner, Krystal Castro. The application is for a facility license to serve four (4) adults, age 18 - 59; all of whom must me ambulatory. The Fire Clearance for this application was approved on July 26, 2022.

During today's inspection LPA observed the following: All indoor and outdoor passageways were free from obstructions. No pools or bodies of water were observed. According to Ms. Castro, there were no firearms, ammunition, or other dangerous weapons in the facility. Toxins, cleaning supplies, and chemicals were locked and inaccessible. LPA toured each room designated as client bedrooms. All rooms had a bed, chair, night stand, dressers, and sufficient lighting available for clients. Administrator provided each client with sufficient hygiene products for personal use. The facility had multiple operating smoke and carbon monoxide detectors that met statutory regulations. LPA observed one fire extinguishers that presented to be in working order. The facility was stocked with a three-day supply of perishable and seven-day supply of nonperishable food items. Medications will be stored in a locked cabinet and will be labeled and maintained in compliance with label instructions. There was a designated secured storage area for Client and staff records according to regulations. LPA reviewed reporting requirements for incident reports as well general operating procedures, continuing requirements, physical environment, and incidental medical services as outlined in Title 22 regulations.

The Pre-licensing and Component III was completed on today's date. Facility is ready to be licensed pending management approval. An exit interview was conducted with the Owner, Castro, to whom a copy of this report and Licensee/Appeals Rights were provided at the conclusion of the visit..
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE: DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/17/2022
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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