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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370804865
Report Date: 06/02/2022
Date Signed: 06/08/2022 03:30:40 PM


Document Has Been Signed on 06/08/2022 03:30 PM - It Cannot Be Edited

Document is an Amendment of Original Document on 06/08/2022 12:46 PM

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

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Licensing Program Analyst (LPA) Vicky Williamson conducted an unannounced visit to the facility to follow up on two self -reported AWOL incidents. LPA was greeted and allowed entry to the facility by Receptionist Cynthia Cerna. LPA met with Bryan Meyers, Administrator and explained the purpose of the visit.

On 4/18/2022, the facility self reported the AWOL of C1 (See LIC811 Confidential Names to identify C1) to Community Care Licensing. C1 was last seen at the facility on 04/16/2022. C1 was able to leave the facility unassisted per the physician report dated 6/29/2021. Staff 1 (S1) contacted C1’s responsible party and the El Cajon Police Department to file a missing person’s report. On 4/18/2022, C1 returned to the facility.

On 5/6/2022, the facility self reported the AWOL of C2 (See LIC811 Confidential Names to identify C2) to Community Care Licensing. C2 left the facility on 5/4/2022. C2 can leave the facility unassisted per the physician report dated 2/11/2020. Staff 2 (S2) contacted C1’s responsible party and the El Cajon Police Department to file a missing person’s report, on 5/5/2022. C1 returned to the facility on the evening of 5/5/2022.

During today's visit, LPA Williamson interviewed Administrator, staff and reviewed the records for C1 and C2. During C 1 and C2’s AWOL, Administrator notified all appropriate parties and followed all procedures and protocol as stated in the facility's Absentee Notification Plan. No deficiencies were issued during today's visit.

An exit interview was conducted with Bryan Meyers, Administrator, to whom a copy of this report and the Licensee's Rights (LIC9058 01/16) were provided.

This is an amended version of the original report left at the facility on 6/2/2022.

SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 06/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/02/2022
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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