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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370804788
Report Date: 11/10/2020
Date Signed: 03/30/2023 02:45:42 PM


Document Has Been Signed on 03/30/2023 02:45 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:CASA EL CAJONFACILITY NUMBER:
370804788
ADMINISTRATOR:REBECCA RAYOFACILITY TYPE:
740
ADDRESS:306 SHADY LANETELEPHONE:
(619) 440-1335
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY:99CENSUS: 92DATE:
11/10/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Administrator Rebecca RayoTIME COMPLETED:
03:48 PM
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Regional Manager (RM), Icela Estrada; Licensing Program Manager (LPM), Simon Jacob, County of San Diego Nurse Contractor Elizar Perez; California Department Public Health (CDPH), Health Facility Evaluator Nurse (HFEN), Jacqueline Ruegg with the HAI Program, conducted an on-site visit. RM, LPM and team identified themselves and discussed the purpose of the visit with Administrator, Rebecca Rayo.

The Department conducted an on-site visit to provide technical assistance and to evaluate the facility's disinfection, testing surveillance, and screening protocols as well as the use of personal protective equipment. During today's visit, the team interviewed Administrator Rebecca Rayo and the team conducted a walk-though of the facility. A debriefing was conducted with Ms. Rayo at the conclusion of the visit.

During today's visit, no deficiencies were issued. An exit interview was conducted with Ms. Rayo and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to the Administrator via electronic mail. An electronic receipt of confirmation was requested to be sent by the Administrator upon receipt of the documents.
SUPERVISOR'S NAME: Kimberly LyonTELEPHONE: (619) 767-2300
LICENSING EVALUATOR NAME: Simon JacobTELEPHONE: (619) 767-2306)
LICENSING EVALUATOR SIGNATURE:
DATE: 11/10/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/10/2020
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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