374604651-2-23-2024-08-AS-AROS-D2QSFH-20240223125023

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604651
Report Date: 02/23/2024
Date Signed: 02/23/2024 12:50:31 PM

Document Has Been Signed on 02/23/2024 12:50 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	HOPE INC IV		FACILITY NUMBER:	374604651
ADMINISTRATOR:	CAMACHO JR, ARTURO		FACILITY TYPE:	775
ADDRESS:	8125 BROADWAY		TELEPHONE:	(619) 933-3077
CITY:	LEMON GROVE	STATE: CA	ZIP CODE:	91945
CAPACITY: 60		CENSUS: 10	DATE:	02/23/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Administrator Richard Covarrubias		TIME COMPLETED:	01:15 PM

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Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Required Annual Inspection to ensure substantial compliance with Title 22 regulations. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Administrator Cythia Vazquez and Administrator Richard Covarrubias and Director Arturo Camacho later joined the visit.

According to the facility’s license, there may be a maximum of sixty ambulatory participants, ages 18 through 59. The facility does not feature a secured perimeter or delayed egress doors.

LPA accompanied by Administrator Covarrubias, toured the interior and exterior of the day program facility. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. There are five (5) working bathrooms in the facility. Doors, sinks, and toilets were in working order. LPA observed incontinence supplies for emergency use. LPA observed areas that are available for privacy such as changing.

Hand hygiene supplies and Personal Protective Equipment were present. The facility provides snacks and lunch as needed however, participants usually bring their own lunch to facility. The facility had sufficient space and equipment to facilitate meetings and client activities including arts, crafts, exercise, computers and community outings. The facility’s ambient internal temperature was comfortable and compliant with Regulations.

[CONTINUED ON LIC809-C]

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024

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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: HOPE INC IV	FACILITY NUMBER: 374604651
	VISIT DATE: 02/23/2024

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There were no sharp objects or toxic chemicals/poisons accessible to clients. No pools or bodies of water were observed on the premises. All fire and carbon monoxide detectors are working. Emergency lighting, and facility telephone were all working. Fire extinguishers were operable, and the last fire drill was competed in February 2024. First aid kits were complete and readily accessible.

LPA interviewed multiple staff and clients. LPA interviews did not raise any licensing concerns. LPA also reviewed multiple staff and client records/files. Files reviewed contained required documents. Confidential records were stored in locked areas. Required licensing postings were observed in visible areas of the facility. LPA observed participants were being treated with dignity by staff, and there were sufficient staff on duty to meet clients’ needs.

Based on today's inspection there are no deficiencies observed at this time in the areas evaluated. An exit interview was conducted, this report was discussed with Director Arturo Camacho and Administrator Richard Covarrubias, along with a copy of the Licensee/Appeal Rights (LIC 9058 01/2106), and their signature on this form acknowledges receipt and a copy of the report was given to Administrator Richard Covarrubias..

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024

LIC809 (FAS) - (06/04)

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