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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370800930
Report Date: 10/23/2023
Date Signed: 10/23/2023 02:02:06 PM

Document Has Been Signed on 10/23/2023 02:02 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: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: DATE:
10/23/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Director of Programs Thomas Carr and Assistant Director of Programming Mark Louis FisherTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself 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 and an SOC341 Report of Suspected Dependent Adult Abuse, which licensee self-submitted to the CCLD San Diego Regional Office (received on 10/04/2023), involving Client #1 (C1) and possibly Client #2 (C2) and Client #3 (C3). [See LIC 811 Confidential Names List for a description of person identifiers used in this report].

During today’s visit, C1 was not in attendance at the day program. LPA performed a facility tour and welfare check on C2, C3, and other clients in care, finding no immediate safety concerns. LPA also collected copies of pertinent records and interviewed relevant staff.

No deficiencies were observed or cited during today's visit.

An exit interview was conducted with Carr and Chief Executive Officer Debra Emerson, to whom a copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2023
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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