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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604798
Report Date: 06/03/2024
Date Signed: 06/03/2024 01:22:23 PM

Document Has Been Signed on 06/03/2024 01:22 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:IGNITE HOME CARE - MARIANFACILITY NUMBER:
374604798
ADMINISTRATOR/
DIRECTOR:		OVERHOLSER, ANAFACILITY TYPE:
735
ADDRESS:4163 MARIAN STTELEPHONE:
(619) 439-6183
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY: 6CENSUS: 0DATE:
06/03/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:54 AM
MET WITH:Ana "Vanessa" Overholser, Administrator
Aster Cruzabra, Licensee		TIME VISIT/
INSPECTION COMPLETED:
01:25 PM
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Licensing Program Analyst (LPA) Renita Hall conducted an announced pre-licensing visit. LPA was allowed entry by Vanessa Overholser, Administrator and Aster Cruzabra, Licensee. LPA identified herself and disclosed the purpose of the visit.

This report summarizes the pre-licensing visit at Ignite Home Care-Marian.  The purpose of the visit was to assess the facility's readiness for operation and compliance with the state's licensing requirements for adult residential facilities. This will be an adult residential facility with a capacity to accommodate 6 ambulatory residents. The facility includes 3 bedrooms, 2 bathrooms, a kitchen, a dining area, a living room, and an outdoor recreational space.

The Administrator has completed the required training and certifications. They demonstrated a clear understanding of their roles and responsibilities. The facility has implemented comprehensive safety measures, including fire extinguishers, smoke detectors, and emergency exit signs. The facility also had bathrooms with handrails and non-slip flooring. The facility's emergency evacuation plan is posted in a visible location and has been granted fire clearance.

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SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE: DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/03/2024
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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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: IGNITE HOME CARE - MARIAN
FACILITY NUMBER: 374604798
VISIT DATE: 06/03/2024
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The facility had developed detailed policies and procedures that cover resident admission, care planning, medication management, incident reporting, and resident rights. These policies and procedures are in line with state regulations and best practices in the field. The bedrooms are spacious and well-lit, and the common areas are clean.

The LPA confirmed there were no tenants in the building, and that it was ready to be licensed, pending management approval. An exit interview was conducted with Administrator , to whom copy of this report, and the Applicant/Appeal Rights (LIC9058), were provided
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024
LIC809 (FAS) - (06/04)
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