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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 371881361
Report Date: 08/11/2022
Date Signed: 08/11/2022 01:31:53 PM


Document Has Been Signed on 08/11/2022 01:31 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:QUIET HILLS LIVINGFACILITY NUMBER:
371881361
ADMINISTRATOR:BLAKE, MARY ANNFACILITY TYPE:
740
ADDRESS:884 GRETNA GREEN WAYTELEPHONE:
(760) 270-2075
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:6CENSUS: 5DATE:
08/11/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:May Blake, AdministratorTIME COMPLETED:
01:40 PM
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Licensing Program Analyst (LPA) Chinwe Nwogene and the County of San Diego Nurse Sandra Brackman with the HAI Program conducted an on-sit visit. LPA Nwogene and Nurse Brackman identified themselves and discussed the purpose of the visit with Administrator, May Blake.

LPA Nwogene and Nurse Brackman conducted the on-site visit to provide technical assistance and to evaluate the facility disinfection, testing surveillance, screening protocols as well as the use of personal protective hygiene, and 6-feet distancing. Administrator Blake was also provided training on how to use the N95 face mask, hand sanitizer and how to dispose the PPE gear.

During today's visit no deficiencies were issued. An exit interview was conducted and a copy of this report was provided to Administrator May Blake.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Chinwe NwogeneTELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:
DATE: 08/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/11/2022
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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