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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370804823
Report Date: 08/29/2024
Date Signed: 08/29/2024 05:00:22 PM


Document Has Been Signed on 08/29/2024 05:00 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:ST. PAUL'S VILLAFACILITY NUMBER:
370804823
ADMINISTRATOR:ELEANOR DOWNINGFACILITY TYPE:
740
ADDRESS:2340 FOURTH AVENUETELEPHONE:
(619) 232-2996
CITY:SAN DIEGOSTATE: CAZIP CODE:
92101
CAPACITY:200CENSUS: 108DATE:
08/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:20 PM
MET WITH:Executive Director LaTressa Downing, Director of Nursing Divina SalinasTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Juliana Barfield conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Director of Nursing Divina Salinas. Executive Director LaTressa Downing joined the visit shortly after.

Today's visit was in response to two (2) LIC624 Incident Reports, which licensee self-submitted to the CCLD San Diego Regional Office (received on 08/23/2024), The first incident involving Resident #1 (R1) and Resident #2 (R2) and the second incident for Resident #1 (R1). [See LIC 811 Confidential Names List for a description of person identifiers used in this report]

During today’s visit, LPA performed a facility tour/welfare check and collected records and conducted interviews. No deficiencies were observed or cited during today's visit.

An exit interview was conducted with LaTressa Downing, 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.

SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Juliana BarfieldTELEPHONE: (619) 994-7269
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2024
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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