374604700-10-10-2023-08-AS-DNGN-CWGTXG-20231010150708

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604700
Report Date: 10/10/2023
Date Signed: 10/10/2023 03:07:30 PM

Document Has Been Signed on 10/10/2023 03:07 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:	INDAYPROGRAMSAC		FACILITY NUMBER:	374604700
ADMINISTRATOR:	MARZEENA, NORA		FACILITY TYPE:	775
ADDRESS:	615 E LEXINGTON AVE		TELEPHONE:	(619) 995-3543
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92020
CAPACITY: 60		CENSUS: 0	DATE:	10/10/2023
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Applicant's Representatives, Nora Marzeena and Ihab Marzeena		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 the applicant’s representatives, Nora Marzeena and Ihab Marzeena.

The facility fire clearance was granted on 05/26/2023 and reflected that the day program facility was approved for sixty (60) clients in total, of which five (5) may be non-ambulatory and none may be bedridden. 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 representatives, 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 78 degrees F. Hot water temperature at taps accessible to clients were also compliant: Kitchen sink was 111.2 F, Bathroom #1 sink was 119.1 F, Bathroom #2 sink was 118.8 F, Bathroom #3 sink was 119.3 F, and Bathroom #4 sink was 118.6 F.

The day program facility has enough snacks for client use. All kitchen appliances were in working order. Refrigerator temperature was 25 F.

[CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023

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: INDAYPROGRAMSAC	FACILITY NUMBER: 374604700
	VISIT DATE: 10/10/2023

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[CONTINUED FROM LIC 809]

The facility has sufficient space and equipment to facilitate 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’s representatives, 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. Fire extinguishers were serviced 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 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. The Marzeenas 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.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023

LIC809 (FAS) - (06/04)

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