374604681-7-21-2023-08-AS-DNGN-CTXU8J-20230721152134

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604681
Report Date: 07/21/2023
Date Signed: 07/21/2023 03:21:45 PM

Document Has Been Signed on 07/21/2023 03:21 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:	WINGS RECOVERY CENTER LLC		FACILITY NUMBER:	374604681
ADMINISTRATOR:	HOSLAR, KATY		FACILITY TYPE:	775
ADDRESS:	785 GRAND AVE SUITE 101 & 102		TELEPHONE:	(858) 220-9519
CITY:	CARLSBAD	STATE: CA	ZIP CODE:	92008
CAPACITY: 30		CENSUS: 13	DATE:	07/21/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Chief Operating Officer Katy Hoslar		TIME COMPLETED:	03:30 PM

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Licensing Program Analyst (LPA) Dang Nguyen conducted an announced Pre-Licensing visit to observe the day program’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’s representative, Chief Operating Officer Katy Hoslar.

The facility fire clearance was granted on 03/16/2023 and reflects that the day program facility was approved for thirty (30) clients in total, of which all must be ambulatory. The fire clearance did not include endorsements for delayed-egress doors or secured perimeter, and neither were present during today's visit. The submitted facility sketch was consistent with the current layout of the facility.

During today’s visit, LPA, accompanied by the applicant’s representative, toured the interior and exterior of the day program 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. Toilets and sinks were in working order. The facility’s ambient internal temperature was complaint at 72 F. Hot water temperature at taps accessible to clients were also compliant: Suite #101 Bathroom sink was 110.5 F, Suite #102 Bathroom sink was 111.6 F, and Suite #102 Kitchen sink was 112.3 F. Kitchen appliances were in working order. Suite #101 Refrigerator temperatures were 39 F, 32 F, and 35 F, respectively. Suite #102 Refrigerator temperature was 39 F, and Suite #102 Freezer temperature was 0 F.

The facility has sufficient space and equipment to facilitate visitation, meetings, and client activities/therapy. 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.

[CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023

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: WINGS RECOVERY CENTER LLC	FACILITY NUMBER: 374604681
	VISIT DATE: 07/21/2023

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[CONTINUED FROM LIC 809]

Smoke alarm, emergency lighting, and facility telephone were all operational. Fire extinguishers were in good condition. 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 the 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. Hoslar was advised that the facility’s application is pending management final review and approval.

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

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023

LIC809 (FAS) - (06/04)

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