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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370804406
Report Date: 11/10/2021
Date Signed: 11/10/2021 04:11:16 PM

Document Has Been Signed on 11/10/2021 04:11 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:GEORGE G. GLENNER ALZHEIMER'S FAMILY CENTER, INC.FACILITY NUMBER:
370804406
ADMINISTRATOR:SCOTT TARDEFACILITY TYPE:
775
ADDRESS:3686 FOURTH AVE.TELEPHONE:
(619) 543-4704
CITY:SAN DIEGOSTATE: CAZIP CODE:
92103
CAPACITY: 24CENSUS: 7DATE:
11/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Maria StefanicTIME COMPLETED:
11:30 AM
NARRATIVE
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit to Activity Coordinator Maria Stefanic.

LPA conducted a brief tour of the facility and observed the clients in care. In accordance with the Department’s Infection Control, LPA provided technical assistance, observed, and evaluated the facility's implementation of their COVID-19 Mitigation Plan, to include disinfection, testing surveillance, screening protocols, and the use of personal protective equipment. No deficiencies were cited on this date.

An exit interview was conducted with Activity Coordinator Maria Stefanic. A copy of this report and the licensee appeal rights (LIC9058 01/16) was provided to Administrator Scott Tarde and Maria Stefanic via E-mail.
SUPERVISORS NAME: Alexandre Vo
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2021
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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