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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370808051
Report Date: 12/23/2022
Date Signed: 12/23/2022 10:11:04 AM

Document Has Been Signed on 12/23/2022 10:11 AM - 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:MARSELL'S ADULT RESIDENTIAL FACILITY #2FACILITY NUMBER:
370808051
ADMINISTRATOR:MARTHA SELLFACILITY TYPE:
735
ADDRESS:1460 E. LEXINGTONTELEPHONE:
(619) 328-0030
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY: 4CENSUS: 4DATE:
12/23/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Caregiver Mariam Santillan WilliamsTIME COMPLETED:
10:10 AM
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Licensing Program Analyst (LPA) Kayla Hilario conducted an unannounced Case Management Visit. LPA was allowed entry, discussed the purpose of the visit, and met Caregiver Mariam Santillan Williams. All staff present have current criminal record clearance.

Today's visit is in response to the self-reported incident which occurred on 11/25/2022 regarding an AWOL of Client 1 (C1 - see LIC811 Confidential Names List).

LPA conducted a wellness check at the facility by touring the facility inside and outside, observing that clients in care appeared appropriate for the facility, interviewing staff and C1, and collecting client records.

According to the Special Incident Report (LIC 624), C1 went AWOL on Friday 11/25/2022 by calling 911 on their own behalf. Facility staff were able to locate client within an hour of discovering they were missing after looking for the client and then immediately contacting law enforcement. Licensee has been advised on Absentee Notification Plan on this day.

No deficiencies were observed or cited.

An exit interview was conducted with Mariam Santillan Williams. A copy of this report and appeal rights (LIC9058 03/22), were provided via hardcopy at the conclusion of the visit.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Kayla Hilario
LICENSING EVALUATOR SIGNATURE: DATE: 12/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/23/2022
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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