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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604785
Report Date: 07/18/2024
Date Signed: 07/19/2024 04:27:18 PM

Document Has Been Signed on 07/19/2024 04:27 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:ANDASOL BOARD AND CAREFACILITY NUMBER:
374604785
ADMINISTRATOR/
DIRECTOR:
TORRES, CESARFACILITY TYPE:
735
ADDRESS:7610 ANDASOL STREETTELEPHONE:
(858) 231-4157
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY: 4CENSUS: DATE:
07/18/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Applicant, Cesar TorresTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA), Natasha Persaud conducted a Prelicensing inspection. An initial application to operate an Adult Residential Facility was received on 12/19/23. The facility was approved to care for four (4) Ambulatory Adult Residents. LPA was greeted and allowed entry into the facility by Applicant, Cesar Torres and met with Applicant and Staff, Lanette Torres.

Structure- The facility is a single story structure with 4 bedrooms and 2 bathrooms. There is an outdoor covered area for client use. No bodies of water were observed.
Bedrooms Residents- Rooms #1-#2 are for Ambulatory clients.
Bedrooms Staff- There are 2 bedrooms for staff use.
Bathrooms- All bathrooms have a working toilet, sink, grab bars and tub/showers with non-skid mats.
Linens & Hygiene Supplies- Adequate supply.
Emergency Phone Numbers, Exit Plan and Required Postings- Posted.
Smoke Detectors and Carbon Monoxide Detectors- Battery operated.
Appliances- Stove burners, oven, microwave, washer, and dryer working.
Toxins- Stored in a locked cabinet.
Water Temperature- Measured at 118 degrees F.
Medications- Centrally stored and locked in a cabinet.
First-Aid Kit- Stored in a locked cabinet.
Resident & Staff Files- Located and locked in the sun room.
Activities- Adequate supplies to include exercising, painting, and puzzles for client's use.
Fire clearance- Approved on 01/11/24.

Component III- Conducted at the Pre-Licensing visit. Information provided about how to operate the facility within substantial compliance.



All items reviewed during the visit are in compliance. Prelicensing is complete and this facility has no deficiencies. Facility appears to be ready for licensure pending final review. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 03/22) were provided to Applicant, Cesar Torres whose signature below confirms receipt of these rights.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2024
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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