374603789-11-7-2023-08-AS-AROS-CXD2WC-20231107164516

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374603789
Report Date: 11/07/2023
Date Signed: 11/07/2023 04:45:35 PM

Document Has Been Signed on 11/07/2023 04:45 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:	LA MESA WORK CENTER ANNEX		FACILITY NUMBER:	374603789
ADMINISTRATOR:	SACOCO, DEONNA		FACILITY TYPE:	775
ADDRESS:	3403 E PLAZA BLVD SUITE H		TELEPHONE:	(619) 267-7796
CITY:	NATIONAL CITY	STATE: CA	ZIP CODE:	91950
CAPACITY: 40		CENSUS: 2	DATE:	11/07/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Licensee/Director Deonna Sacoco		TIME COMPLETED:	04:15 PM

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Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Required Annual Inspection to ensure substantial compliance with Title 22 regulations. The facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Licensee/Director Deonna Sacoco.

According to the facility’s license, there may be a maximum of forty (40) developmentally disabled adults ages 18 and above; of which fifteen (15) may be non-ambulatory. During today’s inspection. The facility does not feature a secured perimeter or delayed egress doors.

LPA’s, accompanied by Director Sacoco, toured the interior and exterior of the day program facility. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. There are three (3) working bathrooms in the facility. Doors, windows, sinks, and toilets were in working order. Hand hygiene supplies and Personal Protective Equipment were present. Facility does not prepare food on the premises and consumers bring their own lunches. Snacks are available as needed. The facility had sufficient space and equipment to facilitate meetings and client activities. The seclusion room has door and lock, assessable by key. The facility’s ambient internal temperature was comfortable and compliant with Regulations. Hot water temperature at taps accessible to clients were also compliant.

There were no sharp objects or toxic chemicals/poisons accessible to clients. No pools or bodies of water were observed on the premises. Signal system is currently hard wired and carbon monoxide detectors are working. Emergency lighting, and facility telephone were all working. Fire extinguishers were operable. First aid kit was complete and readily accessible.

[CONTINUED ON LIC809-C]

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

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: LA MESA WORK CENTER ANNEX	FACILITY NUMBER: 374603789
	VISIT DATE: 11/07/2023

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[CONTINUED FROM LIC809]

LPA interviewed multiple staff and clients. LPA’s interviews did not raise any licensing concerns. LPA also reviewed multiple staff and client records/files. Files reviewed contained required documents. Confidential records were stored in locked areas. Required licensing postings were observed in visible areas of the facility. LPA’s observed consumers were being treated with dignity by staff, and there were sufficient staff on duty to meet consumers’ needs.

Based on today's inspection there are no deficiencies observed at this time in the areas evaluated. An exit interview was conducted, this report was discussed with Licensee/Director Sacoco along with a copy of the Licensee/Appeal Rights (LIC 9058 01/2106), and their signature on this form acknowledges receipt and a copy of the report was given to the with Licensee/Director Sacoco.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 11/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

LIC809 (FAS) - (06/04)

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