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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604361
Report Date: 03/08/2023
Date Signed: 03/08/2023 02:30:14 PM

Document Has Been Signed on 03/08/2023 02:30 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
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:WEAVER'S PRIMROSE VILLAFACILITY NUMBER:
374604361
ADMINISTRATOR:GARDNER, BABETTEFACILITY TYPE:
740
ADDRESS:93 AVENIDA DESCANSOTELEPHONE:
(660) 202-7741
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY: 6CENSUS: 6DATE:
03/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Babette GardnerTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Tammer de los Santos visited the facility to conduct an annual required licensing inspection. LPA was granted entry into the facility by Caregiver Marie Verceles to whom LPA disclosed the purpose of the visit. Administrator Babette Gardner joined later.

LPA conducted a tour of the facility. There are no pools on site. The smoke and carbon monoxide alarms were present. Toilets intended for resident use were operating as intended, and bathing facilities were observed to be clean and kempt. The windows, blinds, and paint throughout the facility, were observed in good condition. Each room intended for resident use had the appropriate furniture, bedding, and appropriate lighting. The linen storage cabinet was observed with a week’s supply of linen and towels. Flashlights were readily available. Caregiver stated there are no firearms stored on the premises.

Hot water temperature was measured at 127 degrees F in the kitchen and 118 degrees F in the bathroom. The Administrator agreed to post a warning sign by the kitchen faucet. The ambient temperature inside the facility was measured at 72 degrees F. The refrigerator and freezer were observed to be clean and operational, with an ample amount of food to meet client needs. A container of milk with expiry date of 03/05/2023 was found in the refrigerator. Caregiver disposed of the milk. Cleaning solutions and knives were properly secured.

A medicine cabinet, located near the living area was observed to be locked, A complete First Aid kit was also available. Client medicine boxes were individually labeled.

No deficiencies were cited during today’s visit. An exit interview was conducted with Caregiver Marie Verceles, and copies of this report and Licensee Rights (LIC 9058) were provided at the conclusion of the visit. Facility representative’s signature on this form acknowledges receipt of the rights and a copy of the report.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tammer DeLosSantos
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2023
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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