374604942-7-29-2025-08-AS-CLOZ-DK2UXK-20250729155828

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604942
Report Date: 07/29/2025
Date Signed: 07/29/2025 03:59:46 PM

Document Has Been Signed on 07/29/2025 03:59 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:	LIVING CIRCLE HOME ARF		FACILITY NUMBER:	374604942
ADMINISTRATOR/ DIRECTOR:	TESTADO, IRENEA		FACILITY TYPE:	735
ADDRESS:	1548 PETAL COURT		TELEPHONE:	(619) 739-0294
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92114
CAPACITY: 5		CENSUS: 0	DATE:	07/29/2025
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:10 PM
MET WITH:	Irenea Testado, Applicant		TIME VISIT/ INSPECTION COMPLETED:	04:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Carmen Lopez conducted an announced Pre-Licensing inspection with the Component III traning, and to observe the facility’s physical plant for complaint with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted at the front entrance by the applicant Irenea Testado and was granted entry after identifying herself and disclosed the purpose of her visit. The facility is a new adult residential facility (ARF) undergoing their initial license. The fire clearance was approved on 05/20/2025 and reflected that the facility was approved for five (5) clients all of whom may be ambulatory in at any given time at the facility site. Their fire clearance was granted with no violations. Their facility sketch was consistent with the current layout of the facility. During today’s visit, LPA accompanied by applicant Testado, conducted an overall inspection of the internal and external areas of the facility. There are two (2) number of bathrooms for clients to use. The facility has all the required furnishings, linens and personal hygiene items. Bathrooms were equipped with non-skid mats. Facility had personal hygiene items stored. The facility was clean, sanitary, and in good repair. Bedrooms allowed for easy passage and no obstruction. Toilets, sinks, and showers were all in working order. Each window screen which was in good condition. The facility’s ambient internal temperature was comfortable and compliant at 77 degrees Fahrenheit (F). Hot water temperature at taps accessible to clients were also compliant: kitchen sink measured hot water at 105 degrees F; sink in bathroom #1 measured at 105.1 degrees F; and sink in bathroom #2 measured hot water at 105.1 degrees F. (Continuation on LIC809-C)

NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Carmen Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: LIVING CIRCLE HOME ARF	FACILITY NUMBER: 374604942
	VISIT DATE: 07/29/2025

NARRATIVE

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(Continuation of LIC809)
All outdoor and indoor pathways were free from obstruction and slip hazards. Fire extinguishers (02) were serviced within the last 12 months and affixed with a current tag and the second was new extinguisher and maintained in the original box. Smoke and carbon monoxide detectors, emergency lighting, and facility phone were present and all operational.

The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and client activities. The facility has no pools or bodies of water that were observed on the facility premises. Per applicant Irenea Testado, no firearms or ammunition are or will be stored on the facility premise.

All toxic substances, poisons, and chemicals were safely stored in an inaccessible cabinet. Fireplaces, and/or open-faced heaters were present and will be inaccessible to clients.

The facility has a locked area for storage of sharp objects inaccessible for clients. The facility kitchen was stocked with appropriate cooking items and utensils. The facility-maintained food items and there was a seven (7) day non-perishable food present; and two (2) day perishable food supply stored. The applicant agreed that once the facility has been approved for licensure and clients have been approved to be admitted the food supply will be maintained.

Medications will be secured in a locked cart which is inaccessible to clients. A first aid kit was present and located in their medication cabinet. The first aid manual will be kept in the medication cabinet. Client and staff files will be kept in a locked cabinet in an inaccessible area of the facility. Licensing postings were observed in visible areas of the facility and were posted.

LPA discussed continuing operation requirements, record keeping, reporting requirements and physical plant compliance with the applicant along with the Component III training. The items reviewed were complaint with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code.

The Pre-Licensing and Component III was completed during today’s visit. The applicant was advised that the facility is ready for licensure pending management final review and approval.

An exit interview was conducted with applicant Irenea Testado, to whom a copy of this report along with the licensee Appeal Rights (LIC 9058 01/16) were provided at the conclusion of the visit. The signature below confirms receipt of these documents.

NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Carmen Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 07/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025

LIC809 (FAS) - (06/04)

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