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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600275
Report Date: 11/30/2021
Date Signed: 12/02/2021 12:56:50 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
FACILITY NAME:SANTEE GOLDEN CAREFACILITY NUMBER:
374600275
ADMINISTRATOR:MYRNA L. BURGINFACILITY TYPE:
740
ADDRESS:10111 LAFE DRIVETELEPHONE:
(619) 562-5104
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY:6CENSUS: 0DATE:
11/30/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Property Owner, Myrna BurginTIME COMPLETED:
03:10 PM
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Licensing Program Analyst (LPA) Debbie Correia conducted a case management visit on today's date for a facility closure. LPA Correia toured the property to ensure there were not residents in care, or staff present on the premises. Closure notices provided to residents and/or responsible parties, and facility relocation of prior residents were confirmed and documented in August 2021. Property owner Myrna Burgin relinquished her original License to LPA Correia.

LPA conducted an exit interview at the conclusion of the visit. LPA emailed Ms. Burgin a copy of this report and requested a read receipt to confirm receipt the documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2021
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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