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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370800930
Report Date: 03/13/2024
Date Signed: 03/19/2024 06:13:54 PM

Document Has Been Signed on 03/19/2024 06:13 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:ST MADELEINE SOPHIES CENTERFACILITY NUMBER:
370800930
ADMINISTRATOR:DEBRA EMERSONFACILITY TYPE:
775
ADDRESS:2119 E. MADISON AVENUETELEPHONE:
(619) 442-5129
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY: 400CENSUS: 340DATE:
03/13/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:01 PM
MET WITH:Director of Programs Thomas Carr and Assistant Director of Programming Mark Louis FisherTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Director of Programs Thomas Carr and Assistant Director of Programming Mark Louis Fisher.

Today's visit was in response to an LIC624 Incident Report which licensee self-submitted to the CCLD San Diego Regional Office (received on 03/13/2024), involving Client #1. [See LIC 811 Confidential Names List for a description of person identifiers used in this report].

LPA gathered copies of pertinent records and briefly spoke to the Directors. No deficiencies were observed or cited during today's visit.

An exit interview was conducted with Thomas Carr and Mark Louis Fisher, to whom a copy of this report, LIC 811 and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2024
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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