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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372008105
Report Date: 12/23/2021
Date Signed: 12/23/2021 01:31:44 PM

Document Has Been Signed on 12/23/2021 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:LEARNING SERVICES ESCONDIDO-ADULT RESIDENTIALFACILITY NUMBER:
372008105
ADMINISTRATOR:BAER, KATHRINFACILITY TYPE:
735
ADDRESS:2335 BEAR VALLEY PARKWAYTELEPHONE:
(760) 746-3223
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY: 28CENSUS: 15DATE:
12/23/2021
TYPE OF VISIT:Case Management - COVID-19ANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Administrator Kathi BaerTIME COMPLETED:
11:10 AM
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Licensing Program Analysts (LPA) Iby Strong, and County of San Diego Nurse Contractor Robert Montillano and Sandra Brackman conducted an on-site visit. LPA and Nurse identified themselves and discussed the purpose of the visit with Administrator, Kathi Baer.

The Department conducted the on-site visit to provide technical assistance and to evaluate the facility's disinfection, screening protocols as well as the use of personal protective equipment. During today's visit, Administrator was interviewed and . A debriefing was conducted with the Administrator at the conclusion of the visit. No deficiencies were issued today.

An exit interview was conducted with the Administrator and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to the Licensee via electronic mail. An electronic receipt of confirmation was requested to be sent by the Licensee upon receipt of the documents.

SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE: DATE: 12/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/23/2021
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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