<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604689
Report Date: 10/30/2024
Date Signed: 10/30/2024 04:20:08 PM

Document Has Been Signed on 10/30/2024 04:20 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:PARKER VILLAFACILITY NUMBER:
374604689
ADMINISTRATOR/
DIRECTOR:		LYNN DRUMMONNFACILITY TYPE:
740
ADDRESS:629 MICHAEL STTELEPHONE:
(619) 625-6886
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY: 6CENSUS: 6DATE:
10/30/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Caregiver Raymond AbedozaTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced Case Management - Annual Continuation visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Raymond Abedoza. LPA spoke with Licensee Zayden Chen via telephone during the visit. Administrator Lynn Drummond arrived during the visit.

During today's visit, LPA observed residents in care, reviewed facility files, and interviewed staff. During the visit, LPA Ruiz observed that Staff 1 (S1) was present and working at the facility. [Administrator was provided with an LIC811 Confidential Names List to identify S1] Review of Guardian revealed that S1's background clearance had expired. Interviews with staff revealed that S1 has been working at the facility for more than 5 days. LPA observed S1 leave the facility prior to the end of the visit. Due to time constraints, the annual inspection could not be completed and a return visit on a subsequent day is needed.

The following deficiency was cited for criminal background clearance and noted on the attached LIC809-D page. Additionally, a civil penalty in the amount of $500 was assessed for uncleared staff and noted on the attached LIC421BG form.

An exit interview was conducted with Administrator Lynn Drummond, whose signature below confirms receipt of a copy of this report, the LIC811, the LIC421BG, and the Licensee Appeal Rights (LIC9058 3/22).
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 10/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/30/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 10/30/2024 04:20 PM - It Cannot Be Edited


Created By: Rebecca A Ruiz On 10/30/2024 at 03:41 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: PARKER VILLA
FACILITY NUMBER: 374604689

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87355(e)(1)
87355 Criminal Record Clearance (e) All individuals subject to a criminal record review... shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department…

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above in that S1 has been working at the facility since August 2024, which poses an immediate safety risk to 6 of 6 residents in care.
POC Due Date: 11/04/2024
Plan of Correction
1
2
3
4
LPA observed S1 leave the facility prior to the end of the visit. Administrator stated that S1 will be getting fingerprinted and associated and S1 will not return to the facility until the Administrator receives S1's clearance letter. Administrator will submit a letter stating that S1 will receive clearance and association prior to returning to the facility to the Department by POC due date of 11/4/2024.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Jennifer Lott
LICENSING EVALUATOR NAME:Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:
DATE: 10/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/30/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2