374604626-4-13-2023-08-AS-DNGN-CQUR56-20230413124237

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604626
Report Date: 04/13/2023
Date Signed: 04/13/2023 12:42:40 PM

Document Has Been Signed on 04/13/2023 12:42 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:	UNEXPECTED POSSIBILITIES INC 3		FACILITY NUMBER:	374604626
ADMINISTRATOR:	STERLING, SHEVELL		FACILITY TYPE:	735
ADDRESS:	1544 PEPPER DR		TELEPHONE:	(619) 277-3520
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92019
CAPACITY: 4		CENSUS: 0	DATE:	04/13/2023
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Applicant Shevell Sterling		TIME COMPLETED:	12:50 PM

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Licensing Program Analyst (LPA) Dang Nguyen conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted by, identified himself to, and explained the purpose of the visit to Applicant Shevell Sterling.

The facility fire clearance was granted on 11-09-2022 and reflects that the facility was approved for 4 clients in total, of which all must be ambulatory.

During today’s visit, LPA, accompanied by the applicant, toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Client bedrooms allowed for easy passage and contained the required furnishings. Toilets, sinks, and showers were in working order. The facility’s ambient internal temperature was 77 degrees F. Water temperature at taps accessible to clients were also compliant: Kitchen sink was 119.8 F, Bathroom #1 sink was 115 F, Bathroom #2 sink was 118.8 F.

The facility has enough linens, hygiene supplies, dining supplies, and perishable and non-perishable food for future client use. All kitchen appliances were in working order. Refrigerator temperature was 40 F, and freezer temperature was 0 F. The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and client activities.

The facility has locked areas for storage of medication and confidential client and staff records. The facility's swimming book was locked behind a gate meeting regulatory requirements. There were no toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Per the applicant, no firearms or ammunition are or will be stored at the facility.

[CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: UNEXPECTED POSSIBILITIES INC 3	FACILITY NUMBER: 374604626
	VISIT DATE: 04/13/2023

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[CONTINUED FROM LIC 809]

Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. Two (2) fire extinguishers and two (2) complete first aid kits were present. Required licensing postings were observed in visible areas of the facility.

The items reviewed were complaint with Title 22, Division 6 of California Code of Regulations and California Health & Safety Code. The applicant passed the pre-licensing inspection.

LPA also provided the Component III Training during today’s visit. Sterling was advised that the facility’s application is pending management final review and approval.

An exit interview was conducted with the applicant, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023

LIC809 (FAS) - (06/04)

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