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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600488
Report Date: 12/14/2020
Date Signed: 12/14/2020 05:21:23 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:CASA DE LAS CAMPANASFACILITY NUMBER:
374600488
ADMINISTRATOR:KIMBERLY FINCH-DOMINYFACILITY TYPE:
741
ADDRESS:18655 WEST BERNARDO DRIVETELEPHONE:
(858) 451-9152
CITY:SAN DIEGOSTATE: CAZIP CODE:
92127
CAPACITY:582CENSUS: 491DATE:
12/14/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Shila Jurado, Director of Res. Cont. CareTIME COMPLETED:
03:25 PM
NARRATIVE
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Licensing Program Manager (LPM), Denise Powell, County of San Diego Nurse Contractor Elizar Perez; California Department Public Health (CDPH), and Health Facility Evaluator Nurse (HFEN), Jacqueline Ruegg with the HAI Program, conducted an on-site visit. LPM and team identified themselves and discussed the purpose of the visit with Director of Resident Services, Shila Jurado.

The Department conducted the on-site visit to provide technical assistance and to evaluate the facility's disinfection, testing surveillance, screening protocols as well as the use of personal protective equipment. During today's visit, the team interviewed Ms. Jurado and conducted a walk-though of the facility. A debriefing was conducted with Ms. Jurado at the conclusion of the visit.

During today's visit, no deficiencies were issued. An exit interview was conducted and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to her via electronic mail with electronic signatures used, An electronic receipt of confirmation was requested to be sent by the Administrator upon receipt of the documents.
SUPERVISOR'S NAME: Icela EstradaTELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Denise PowellTELEPHONE: 619-301-9770
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2020
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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