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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370808536
Report Date: 08/12/2020
Date Signed: 08/12/2020 04:46:48 PM

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:JARY BARRETO CRISIS CENTERFACILITY NUMBER:
370808536
ADMINISTRATOR:NODERER, MARTHAFACILITY TYPE:
772
ADDRESS:2865 LOGAN AVENUETELEPHONE:
(619) 232-4357
CITY:SAN DIEGOSTATE: CAZIP CODE:
92113
CAPACITY:14CENSUS: 7DATE:
08/12/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Sarah Robinson, Asst. Program DirectorTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Daniel Pena conducted a Virtual Case Management Visit due to COVID-19. LPA introduced and identified himself to Sarah Robinson, Assistant Program Director. The virtual visit was conducted using the Zoom video conferencing application. LPA explained the purpose of the call to Assistant Director Robinson.

The virtual visit was in response to a self-reported client AWOL which occurred on 08/03/2020. A LIC624 Unusual Incident/Injury Report was received at CCL on 08/10/2020. On 08/03/2020 at about 7:00 PM, staff observed Client 1 (Licensee was provided with the LIC811 Confidential Names to identify C1) in their assigned bedroom during a milieu check. At 7:30 PM, staff observed that C1 was no longer in the facility or on its grounds. According to the report, C1 denied suicidal ideation, self-harm and any other safety concerns. Staff checked C1's records and determined that C1 did not have an emergency contact listed. Staff also notified the Program Director of the client's absence. Staff held C1's bed until 2400 hours but the client did not return to the facility.

During today's visit, LPA interviewed staff and reviewed facility records. LPA reviewed the facility's client welfare check protocols which are conducted every thirty minutes. LPA also reviewed the facility's Absentee Notification Plan. LPA provided staff consultation regarding AWOL procedures.

No deficiencies were cited during the visit.

An exit interview was conducted with Assistant Director Robinson by telephone. A copy of this report, LIC811 Confidential Names and the Licensee/Appeal Rights (LIC9058 01/16) were provided to Ms. Robinson via email and an electronic read receipt verifies receipt of the documents
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 994-7269
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2020
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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