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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 134600626
Report Date: 04/19/2022
Date Signed: 04/20/2022 04:39:20 PM

Document Has Been Signed on 04/20/2022 04:39 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:SMOKETREEFACILITY NUMBER:
134600626
ADMINISTRATOR:ELIZABETH WAYCOTTFACILITY TYPE:
735
ADDRESS:1663 SMOKETREE DRIVETELEPHONE:
(760) 353-6203
CITY:EL CENTROSTATE: CAZIP CODE:
92243
CAPACITY: 6CENSUS: 6DATE:
04/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Administrator Elizabeth WaycottTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA), Kayla Hilario, and Licensing Program Analyst, Rebecca Ruiz, conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPAs were allowed entry and met with Administrator Elizabeth Waycott to whom they identified themselves and discussed the purpose of the visit. All staff present have a current criminal record clearance.

LPAs conducted a tour of the facility, both inside and outside. In accordance with the Department’s Infection Control, LPAs provided technical assistance, evaluated, and observed the facility's implementation of their mitigation plan to include disinfection, testing surveillance, and screening protocols as well as the use of personal protective equipment.

No deficiencies were cited or observed on this date.

An exit interview was conducted with Administrator Elizabeth Waycott. A copy of this report and appeal rights (LIC9056 01/16), were provided via hardcopy at the conclusion of the visit.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Kayla Hilario
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2022
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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