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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370800930
Report Date: 05/24/2024
Date Signed: 05/31/2024 11:18:58 PM

Document Has Been Signed on 05/31/2024 11:18 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/
DIRECTOR:		DEBRA EMERSONFACILITY TYPE:
775
ADDRESS:2119 E. MADISON AVENUETELEPHONE:
(619) 442-5129
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY: 400CENSUS: 344DATE:
05/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:CEO Debra EmersonTIME VISIT/
INSPECTION COMPLETED:
01:30 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 CEO Debra Emerson.

Today's visit was in response to a licensee self-reported driving incident. An Unusual Incident Report was received at the CCLD San Diego Regional Office on 05/09/2024. [See LIC 811 Confidential Names List for a description of residents]. Per the self-reported document, on the afternoon of 05/06/24 four (4) clients who were being transported in the program bus were involved in a minor accident. The program bus swiped another vehicle while turning, hitting the other vehicle’s side mirror only.

A police report was filed and no clients were injured. The driver participated in a driving re-training program. No deficiencies were cited during today’s visit.

An exit interview was conducted with Debra, whose signature below confirms receipt of a copy of this report, the LIC811 and the Licensee Rights (LIC 9058 01/16).

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2024
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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