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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370801896
Report Date: 08/26/2020
Date Signed: 08/26/2020 09:58:45 AM

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:VOA - TROY CENTER FOR SUPPORTIVE LIVINGFACILITY NUMBER:
370801896
ADMINISTRATOR:SHANNON, DENISEFACILITY TYPE:
735
ADDRESS:8627 TROY STREETTELEPHONE:
(619) 465-8792
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:40CENSUS: 40DATE:
08/26/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Marisabel Salinas, AdministratorTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA)Tiffany Holmes contacted the facility via tele-virtual/face time visit to follow up on an incident report that was received in the office on 08/25/2020 due to COVID-19. LPA identified herself and discussed the purpose of the call with Administrator Marisabel Salinas.

Incident report dated 08/18/2020 regarding Client 1 (C1) (See LIC 811 Confidential Names) AWOLing on 08/15/2020. C1 was last seen at the facility on 08/15/2020. Administrator contacted C1s responsible party and the Sheriff's department to file a missing persons report. As of today, 08/26/2020 C1 has not returned to the facility. The administrator also contacted several hospitals in the surrounding areas to try and locate C1.

Facility followed the appropriate measures and called the sheriff in a timely manner. Facility also followed their absentee notification plan for C1.

No deficiencies are being cited today during visit.

An exit interview was conducted with Administrator Salinas via face time and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) was provided to Administrator Salinas via email. An electronic email read receipt confirms the documents were received.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Tiffany HolmesTELEPHONE: (619) 481-0843
LICENSING EVALUATOR SIGNATURE:

DATE: 08/26/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2020
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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