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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603661
Report Date: 05/30/2024
Date Signed: 05/30/2024 03:49:27 PM

Document Has Been Signed on 05/30/2024 03:49 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:BUTTERFLY GARDENS IIFACILITY NUMBER:
374603661
ADMINISTRATOR/
DIRECTOR:
LEO ESPINOSAFACILITY TYPE:
740
ADDRESS:5557 SOLEDAD MOUNTAIN ROADTELEPHONE:
(858) 764-4442
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY: 6CENSUS: 6DATE:
05/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Administrator Leo EspinosaTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Required Annual Inspection. The LPA introduced himself and disclosed the purpose of the visit to Administrator Leo Espinosa. The facility was approved for a capacity of six (6) non-ambulatory residents, of which one (1) could be bedridden. The facility also had a hospice waiver for three (3) residents.

The LPA, accompanied by staff, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to clients. Medications were labeled, and stored in a locked area.



A pool was observed to be secured and inaccessible to residents in care. Per staff, no firearms, nor ammunition were kept at the facility. A Carbon monoxide detector was tested and operational. A fire extinguisher, first aid kit and a working telephone were present.

Due to time constraints, a return visit on a subsequent day is needed to complete the annual inspection.

An exit interview was conducted with Administrator Leo Espinosa, to whom a copy of this report, and Licensee/Applicant Rights (LIC 9058), were provided.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 05/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/30/2024
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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