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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604751
Report Date: 10/17/2024
Date Signed: 10/17/2024 03:55:52 PM

Document Has Been Signed on 10/17/2024 03:55 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:NANCY VASQUEZ RESIDENTIAL CARE CENTERFACILITY NUMBER:
374604751
ADMINISTRATOR/
DIRECTOR:		CURTIS, PHILIP C.FACILITY TYPE:
735
ADDRESS:8627 TROY STREETTELEPHONE:
(619) 754-5250
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY: 40CENSUS: 35DATE:
10/17/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:14 PM
MET WITH:Nick Fierro, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Tiffany Holmes conducted a Case Management visit. LPA was greeted and allowed entry into the facility by Nick Fierro, Administrator. LPA stated the purpose of the visit was to follow up on the incident report from 10/11/2024 that was received on 10/15/2024 regarding client AWOL.

During today's visit, LPA briefly toured the facility, requested records, and conducted interviews. LPA Holmes is conducting a health and safety check regarding Client 1 (C1). The client (C1) returned to the facility on 10/14/2024 and was at the facility for evening medications and then took off again during overnight shift, early morning on 10/15/2024. The administrator and LPA went over the new and updated absentee notification plan which states they will contact the police within 72 hours instead of the original 24 hrs. C1 is able to leave the facility unassisted according to their physicians report dated 12/11/2023.
C1 has a history of AWOL'ing (wandering and walking off). The administrator stated that C1 has not been med complaint and thinks that them pushing C1 to become med complaint is what led to the AWOL.

No deficiencies were seen or issued during today's visit.

An exit interview was conducted with Administrator and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 03/22), were provided to the Administrator at the conclusion of the visit.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2024
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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