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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600411
Report Date: 07/29/2021
Date Signed: 07/29/2021 04:14:46 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
FACILITY NAME:MISSION HOME IIFACILITY NUMBER:
374600411
ADMINISTRATOR:JOHN CURMAKFACILITY TYPE:
740
ADDRESS:2997 MELBOURNE DRIVETELEPHONE:
(858) 569-4028
CITY:SAN DIEGOSTATE: CAZIP CODE:
92123
CAPACITY:6CENSUS: 4DATE:
07/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:32 PM
MET WITH:Caregiver Nora RiveraTIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Rebecca Ruiz and Licensing Program Manager (LPM) Rebecca Hedgecock conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPA and LPM were greeted by, identified themselves to, and explained the purpose of the visit to Caregiver, Nora Rivera. All staff present have a current criminal record clearance. Administrator Ceren Curmak arrived later during the visit.

LPA and LPM conducted a brief tour of the facility, both inside and outside, and observed the clients in care. In accordance with the Department’s Infection Control, LPA and LPM provided technical assistance and observed and evaluated the facility's implementation of their COVID-19 Mitigation Plan, to include disinfection, testing surveillance, screening protocols, and the use of personal protective equipment. No deficiencies were cited or observed on this date.

An exit interview was conducted with Caregiver Nora Rivera and Administrator Ceren Curmak. A copy of this report and the licensee appeal rights (LIC9058 01/16) were provided to Ceren Curmak via E-mail.
SUPERVISOR'S NAME: Alexandre VoTELEPHONE: (619) 385-7506
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
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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