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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372004506
Report Date: 07/26/2021
Date Signed: 07/27/2021 08:15:42 AM

Document Has Been Signed on 07/27/2021 08:15 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:CARPEL BOARD & CARE FACILITY #2FACILITY NUMBER:
372004506
ADMINISTRATOR:CARMONA, LEONOR P.FACILITY TYPE:
740
ADDRESS:2091 HANFORD DRIVETELEPHONE:
(858) 569-1691
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY: 6CENSUS: 6DATE:
07/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Administrator Leonor CarmonaTIME COMPLETED:
04:30 PM
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Licensing Program Analysts (LPAs) Dang Nguyen and Rebecca Ruiz conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPAs were greeted by, identified themselves to, and explained the purpose of the visit to Administrator Leonor Carmona. All staff present have a current criminal record clearance.

LPAs conducted a brief tour of the facility, both inside and outside, and observed the clients in care. In accordance with the Department’s Infection Control, LPAs provided technical assistance and observed and evaluated the facility's implementation of their COVID-19 Mitigation Plan, to include disinfection, testing surveillance, screening protocols, and the use of personal protective equipment. No deficiencies were cited on this date.

An exit interview was conducted with Administrator Leonor Carmona, to whom a copy of this report and the licensee appeal rights (LIC9058 01/16) were provided via E-mail.
SUPERVISORS NAME: Alexandre Vo
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2021
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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