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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604095
Report Date: 08/16/2021
Date Signed: 08/16/2021 06:47:01 PM

Document Has Been Signed on 08/16/2021 06:47 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:HUNTINGTON CHATEAUFACILITY NUMBER:
374604095
ADMINISTRATOR:DERAFERA, LYNDON M.FACILITY TYPE:
740
ADDRESS:14934 HUNTINGTON GATE DRTELEPHONE:
(858) 231-4126
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 6CENSUS: 6DATE:
08/16/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Lyndon Derafera, AdministratorTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Dawn Segura visited the facility to conduct an annual required licensing inspection. LPA was granted entry into the facility and met with Lyndon Derafera, Administrator, with whom she discussed the purpose of the visit.

During today's visit, LPA toured the facility and verified compliance with infection control practices. LPA and Administrator reviewed the facility’s Plan for Epidemic Outbreak Specific to COVID-19 Mitigation. LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff and visitors; a sign-in policy enacted for all visitors; signs posted at facility entrance with the facility’s visitor policy, and signs in the facility to promote hand hygiene and cough/sneeze etiquette; hand sanitizer/hand washing stations readily available; available visitation areas; emergency agencies’ contact information visible to staff; and an adequate supply of cleaning products and PPE. Upon arrival, LPA observed that staff were not wearing face coverings; however, later during the visit, staff were observed wearing appropriate face coverings.

No deficiencies were cited during today’s visit. An exit interview was conducted with Lyndon Derafera, Administrator, and a copy of this report and Licensee Rights (LIC 9058 FAS 01/16) were provided to the administrator via email following the visit. An electronic receipt of confirmation was requested to be sent to LPA upon receipt of the documents.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2021
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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