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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604608
Report Date: 11/19/2024
Date Signed: 11/20/2024 01:09:45 PM

Document Has Been Signed on 11/20/2024 01:09 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:VIBRANT LIVING IIFACILITY NUMBER:
374604608
ADMINISTRATOR/
DIRECTOR:		NORRIS, JULIEFACILITY TYPE:
740
ADDRESS:6140 CRAWFORD STREETTELEPHONE:
(619) 929-1730
CITY:SAN DIEGOSTATE: CAZIP CODE:
92123
CAPACITY: 6CENSUS: 6DATE:
11/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 PM
MET WITH:Administrator Julie NorrisTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Caregiver Natalia Valdes. Administrator Julie Norris arrived later during the visit. The facility's license shows a maximum capacity of 6 non-ambulatory residents. During today’s inspection there were 6 residents in care.
 
LPA with Administrator Norris toured the interior and exterior of the facility, and inspected each room. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings.  Doors, windows, screens, toilets, and showers were in working order. Hot water temperature at taps accessible to residents were not compliant, sink in restroom #1 delivered hot water at 137.1 degrees F; sink in restroom #2 delivered hot water at 136.2 degrees F; sink in restroom #3 delivered hot water at 136.6 degrees F; sink in restroom #4 delivered hot water at 135.3 degrees F.  Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. 

The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and residents activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored.  Cooking, dining equipment, and utensils were present.  No toxic chemicals or poisons were accessible to residents.  Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Administrator Norris, no firearms or ammunition are kept at the facility.  Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order.  Fire extinguisher was serviced within the last 12 months.  First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility.


[CONTINUED ON LIC809-C)
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Hannah Rodgers
LICENSING EVALUATOR SIGNATURE: DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/19/2024
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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Document Has Been Signed on 11/20/2024 01:09 PM - It Cannot Be Edited


Created By: Hannah Rodgers On 11/19/2024 at 04:12 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: VIBRANT LIVING II
FACILITY NUMBER: 374604608

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(e)(2)
Maintenance and Operation
(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in four (4) out of four (4) faucets which posed a potential health and safety risk to six (6) out of six (6) persons in care.
POC Due Date: 12/03/2024
Plan of Correction
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Administrator turned down the hot water heater during the LPA's visit. Adminstrator agrees to contact their maintenance company to service the hot water heater to ensure the hot water is within regulations. Administrator agreed to inform the Department once all their hot waters have been adjusted by sending pictures of a thermometer under all bathroom faucets by the POC due date of 12/03/2024.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lizzette Tellez
LICENSING EVALUATOR NAME:Hannah Rodgers
LICENSING EVALUATOR SIGNATURE:
DATE: 11/19/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/19/2024


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: VIBRANT LIVING II
FACILITY NUMBER: 374604608
VISIT DATE: 11/19/2024
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[CONTINUED FROM LIC809]

LPA interviewed staff and residents, and reviewed facility records. The files reviewed by LPA contained required documents.  Confidential records were stored in locked areas.

One deficiency was cited in accordance with CCR Title 22. An exit interview was conducted with Administrator Norris to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Hannah Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2024
LIC809 (FAS) - (06/04)
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