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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604751
Report Date: 04/15/2024
Date Signed: 04/16/2024 08:57:17 AM

Document Has Been Signed on 04/16/2024 08:57 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:NANCY VASQUEZ RESIDENTIAL CARE CENTERFACILITY NUMBER:
374604751
ADMINISTRATOR:CURTIS, PHILIP C.FACILITY TYPE:
735
ADDRESS:8627 TROY STREETTELEPHONE:
(619) 754-5250
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY: 40CENSUS: 40DATE:
04/15/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Phillip Curtis, Owner &
Nick Fierro, Administrator		TIME COMPLETED:
12:13 PM
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Licensing Program Analyst (LPA) Tiffany Holmes 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 herself to, and explained the purpose of the visit to the applicant’s representatives, Phillip Curtis, Owner & Nick Fierro, Administrator.

The facility fire clearance was granted on 03/29/2024 and reflected that the facility was approved for forty (40) clients in total, of which all must be ambulatory. The facility's 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 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 complaint at 69 degrees F. Hot water temperature at taps accessible to clients were also compliant: Building 1- Building 3 the Bathrooms were between 105.1- 125.8 degrees.

The facility has enough linens, hygiene supplies, cooking and dining supplies, and perishable and non-perishable food for future client use. All kitchen appliances were in working order. Kitchen Refrigerator temperature was 40 F, and Kitchen Freezer temperature was 0 F. Overflow Freezer temperature was 0 F.


[CONTINUED ON LIC 809-C]
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/15/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
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: NANCY VASQUEZ RESIDENTIAL CARE CENTER
FACILITY NUMBER: 374604751
VISIT DATE: 04/15/2024
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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 sharp objects, 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 detector, emergency lighting, and facility telephone were all operational. The facility's fire extinguisher was serviced within the last twelve 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. Phillip Curtis, Owner &
Nick Fierro, Administrator and they 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: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 04/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024
LIC809 (FAS) - (06/04)
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