374604646-5-24-2023-08-AS-DNGN-CS5NYN-20230524105300

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604646
Report Date: 05/24/2023
Date Signed: 05/24/2023 10:53:06 AM

Document Has Been Signed on 05/24/2023 10:53 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:	PEOPLE'S CARE OCEANVIEW		FACILITY NUMBER:	374604646
ADMINISTRATOR:	POUESI, AGAIOTUPU		FACILITY TYPE:	735
ADDRESS:	5974 OCEANVIEW RIDGE LANE		TELEPHONE:	(909) 287-3557
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92121
CAPACITY:	4	CENSUS: 0	DATE:	05/24/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Applicant's Representatives, District Manager Jose Guzman and Administrator Hector Padilla		TIME COMPLETED:	11:00 AM

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Licensing Program Analysts (LPA's) Dang Nguyen and Riza Alvarez 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. LPAs were greeted by, identified themselves to, and explained the purpose of the visit to the applicant's representatives, District Manager Jose Guzman and Administrator Hector Padilla.

The facility's fire clearance was granted on 03/15/2023 and reflects that the facility was approved for four (4) clients in total, of which all must be ambulatory. The submitted facility sketch is consistent with the current layout of the facility. The facility's fire clearance does not include endorsements for delayed-egress doors or secured perimeter, and neither of those was present during today's visit.

During today’s visit, LPAs, accompanied by the applicant's representatives, 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 trip 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 68 degrees F. Hot water temperature at taps accessible to clients were also compliant: Kitchen sink was 112.3 F, Bathroom #1 sink was 112.6 F, Bathroom #2 sink was 116.8 F, Bathroom #3 sink was 115.3 F, and Laundry room sink was 115.5 F.

The facility has enough linens, hygiene supplies, cooking and dining supplies, and perishable and non-perishable food for client use. All kitchen appliances were in working order. Kitchen and garage refrigerator temperatures were 39 F, and kitchen and garage freezer temperatures were 0 F.

[CONTINUED ON LIC 809-C]

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

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: PEOPLE'S CARE OCEANVIEW	FACILITY NUMBER: 374604646
	VISIT DATE: 05/24/2023

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[CONTINUED FROM LIC 809]

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. No pools or bodies of water were observed on the premises. 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.

Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. All fire extinguishers were professionally serviced/inspected within the last 12 months. A complete first aid kit was 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.

LPAs also provided the Component III Training during today’s visit. Guzman and Padilla were advised that the facility’s application is pending management final review and approval.

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

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang Nguyen	TELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023

LIC809 (FAS) - (06/04)

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