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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 371881347
Report Date: 01/25/2023
Date Signed: 01/25/2023 11:10:53 AM

Document Has Been Signed on 01/25/2023 11:10 AM - 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:KELLY'S ALMAGRO VILLAFACILITY NUMBER:
371881347
ADMINISTRATOR:WELKER, KELLYFACILITY TYPE:
740
ADDRESS:1889 ALMAGRO LANETELEPHONE:
(619) 504-5049
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY: 6CENSUS: 6DATE:
01/25/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:ADMINISTRATOR, GARRETT WELKER.TIME COMPLETED:
11:15 AM
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On January 25, 2023, Licensing Program Analyst (LPA), Venus Mixson conducted a scheduled visit for the purpose of conducting a pre-licensing inspection. LPA Mixson met with Administrator and toured facility inside and outside.
Facility is a single story home with six bedrooms, one office, three restrooms, a living room, dinning room, kitchen, and two car garage with backyard. On 06/30/2022, The Escondido County Fire Department approved the facility for zero ambulatory, six non-ambulatory, and zero bedridden residents. LPA Mixson observed medications were centrally stored and locked. The facility is equipped with lights in the passages, and stocked with emergency night lights throughout the facility. The smoke and carbon monoxide detectors were tested and are operable. LPA Mixson observed the fire extinguisher charged and in the green. LPA Mixson observed cleaning supplies are locked in laundry area. The sharp objects are locked in a kitchen drawer. All doors, and passageways are clear from obstruction. There were no bodies of water, fire place was covered with screen. LPA Mixson observed beds have the required linen and supplies. There was enough clean linen and hygiene items. There was appropriate lighting in each room with night stand, dresser and chair.
LPA Mixson observed central heating and air conditioning systems.
The Administrator dialed the land line phone number (760) 975-3539 and it was operable. Outside/Yards: No obstructions observed. Component III reviewed.
An exit interview was conducted, a copy of this report was provided to Administrator.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2023
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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