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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600546
Report Date: 10/17/2023
Date Signed: 10/17/2023 03:49:54 PM

Document Has Been Signed on 10/17/2023 03:49 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:CAL-CRIS LODGEFACILITY NUMBER:
374600546
ADMINISTRATOR:GLADYS BELTRANFACILITY TYPE:
735
ADDRESS:8944 EMERALD GROVE AVENUETELEPHONE:
(619) 390-8501
CITY:LAKESIDESTATE: CAZIP CODE:
92040
CAPACITY: 10CENSUS: 9DATE:
10/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Julita Renojo, Care giverTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPAs) Amy Rodgers conducted an unannounced visit to commence a Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with caregiver, Julita Renojo. Caregiver Renojo called licensee Jun Beltran. LPA Rodgers did discuss proper medication storage with licensee Jun Beltran and he assured me he would get a locked cabinet for the medication within 24 hours.

During today’s visit, LPA briefly toured the facility, interviewed staff and one client. No deficiencies were cited during today’s visit. Due to time constraints, a return visit on a subsequent day is needed to complete the annual inspection.

An exit interview was conducted with the Caregiver Julita Renojo, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE: DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2023
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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