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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604608
Report Date: 11/08/2022
Date Signed: 11/09/2022 08:54:22 AM


Document Has Been Signed on 11/09/2022 08:54 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:VIBRANT LIVING IIFACILITY NUMBER:
374604608
ADMINISTRATOR:NORRIS, JULIEFACILITY TYPE:
740
ADDRESS:6140 CRAWFORD STREETTELEPHONE:
(619) 929-1730
CITY:SAN DIEGOSTATE: CAZIP CODE:
92123
CAPACITY:6CENSUS: 0DATE:
11/08/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Applicant Julie Noris TIME COMPLETED:
11:10 AM
NARRATIVE
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Licensing Program Analyst (LPA) Iby Strong, conducted an announced Pre-Licensing inspection. LPA met with Applicant Julie Noris and Quentin Noris discussed the purpose of the visit.

LPA conducted a tour of the facility, both inside and outside. Fire clearance has been granted for 6 non-ambulatory residents. According to the Department's Centralized Application Bureau, this facility's pending licensure includes a care program specific for residents with a Major Neurocognitive Disorder. During today's visit, LPA observed the backyard fencing is incomplete, leading down towards a steep downhill slope. In addition, the facility has not submitted an LIC999 (Facility Sketch), identifying the outside of the facility's property. As of today, the Pre-Licensing is incomplete. A follow up Pre-Licensing LIC809 will be generated upon the completion of the backyard fencing, and submission of an LIC999 for the outside of the facility.

An exit interview was conducted. The Applicant will be provided a copy of their Appeal/Licensee rights (LIC9058 03/22) and this report on todays date.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Iby StrongTELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2022
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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