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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600546
Report Date: 10/16/2024
Date Signed: 10/16/2024 05:03:01 PM

Document Has Been Signed on 10/16/2024 05:03 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/
DIRECTOR:		GLADYS BELTRANFACILITY TYPE:
735
ADDRESS:8944 EMERALD GROVE AVENUETELEPHONE:
(619) 390-8501
CITY:LAKESIDESTATE: CAZIP CODE:
92040
CAPACITY: 10CENSUS: 9DATE:
10/16/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:04 PM
MET WITH:Caregiver Julita RenojoTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to obtain signatures on two amended reports. During today’s visit, LPA was greeted by Maria Theresa Torres, identified herself, and met with and discussed the purpose of the visit.

During today’s visit, LPA obtained signatures on two amended versions of a report originally delivered on June 4, 2024 and September 5, 2024, each.

An exit interview was conducted with Volunteer Torres and a copy of this report and the Licensee Appeal Rights (LIC 9058 3/22) were provided.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE: DATE: 10/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/16/2024
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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