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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604260
Report Date: 05/11/2022
Date Signed: 05/11/2022 11:16:20 AM

Document Has Been Signed on 05/11/2022 11:16 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:WEAVER'S TWIN OAKS VILLAFACILITY NUMBER:
374604260
ADMINISTRATOR:WEAVER, TONYAFACILITY TYPE:
740
ADDRESS:2115 TWIN OAKS VALLEY ROADTELEPHONE:
(760) 798-4141
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY: 6CENSUS: 6DATE:
05/11/2022
TYPE OF VISIT:Case Management - COVID-19ANNOUNCEDTIME BEGAN:
10:33 AM
MET WITH:Tonya Weaver, AdministratorTIME COMPLETED:
11:25 AM
NARRATIVE
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Licensing Program Analyst Yolanda Delgado and Licensing Program Manager Jazmond Harris and the County of San Diego Nurse Robert Montillano with the HAI Program, conducted an on-site visit. The team identified themselves and discussed the purpose of the visit with Licensee Tonya Weaver and Administrator assistant Babette Gardner.

The Department and HAI Team conducted the on-site visit to provide technical assistance and to evaluate the facility’s disinfection, testing surveillance, screening protocols as well as the use of personal protective equipment. During today’s visit, the HAI team discussed the proper use of disinfectant and supplies, proper cleaning methods, proper use of diluted bleach solution and retain use time, how to perform hand hygiene, proper place of PPE storage, utilizing PPE and 6-feet distancing. A debriefing was conducted with Licensee Weaver at the conclusion of the visit.

During today’s visit, no deficiencies were issued. An exit interview was conducted with Licensee Weaver and Administrator assistant Gardner, and a copy of this repor were provided to Licensee Weaver.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE: DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/11/2022
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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