<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370804788
Report Date: 03/05/2024
Date Signed: 03/05/2024 03:44:50 PM


Document Has Been Signed on 03/05/2024 03:44 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: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: 95DATE:
03/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Med Receptionist Eveline DentonTIME COMPLETED:
03:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
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 Med Receptionist Eveline Denton.

Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office (received on 03/04/2024). According to the LIC624: on 02/29/24, Resident #1 (R1) left the facility and did not return. [See LIC 811 Confidential Names List for a description of R1.]

As of today’s (03/05/24) licensing visit, R1 has not yet returned to the facility. LPA performed a facility tour and welfare check on the other remaining clients in care, finding no immediate safety concerns. LPA also reviewed pertinent records and interviewed relevant staff and residents.

According to R1’s latest LIC602 Physician’s Report (dated 08/31/22): R1’s primary diagnosis is schizophrenia. Their doctor determined that R1 was able to safely leave the facility unassisted. Interview with staff and residents did not reveal any information regarding changes in condition or issues with medication management. The facility Administrator filed a missing person's report with the local police department immediately.

CCLD concluded: The Administrator followed appropriate CCLD regulatory protocols and reported the incident to the appropriate agencies and authorities.

No deficiencies were cited for the above incident. No deficiencies were observed or cited during today's visit.

An exit interview was conducted with Eveline, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 767-2311
LICENSING EVALUATOR NAME: Liliana SilveiraTELEPHONE: (619) 481-0844
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1