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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600661
Report Date: 03/03/2023
Date Signed: 02/07/2024 04:58:42 PM


Document Has Been Signed on 02/07/2024 04:58 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:CALIFORNIA HOME FOR SENIORSFACILITY NUMBER:
374600661
ADMINISTRATOR:GLORIA S. QUILLOPEFACILITY TYPE:
740
ADDRESS:1061 E. BRADLEY AVENUETELEPHONE:
(619) 448-2870
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY:15CENSUS: 9DATE:
03/03/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:53 PM
MET WITH:Lead Caregiver Priscilla DizonTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Liliana Silveira conducted a case management visit to give a technical advisory for issues identified while at the facility for an unrelated visit. LPA Silveira gained access to the facility and met with Lead Caregiver Priscilla Dizon and explained the purpose of the Case Management.

On March 3, 2023, while LPA Silveira was at the facility, LPA observed perishable food items without a label or a container in the refrigerator, as well as expired food items.

A technical advisory was given Per Title 22, Division 6, Chapter 8 of the California Code of Regulations (see LIC9102). An exit interview was conducted with Lead Caregiver Priscilla Dizon, to whom a copy of this report and the Licensee Appeal Rights (LIC9058) were provided.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 301-9770
LICENSING EVALUATOR NAME: Liliana SilveiraTELEPHONE: (619) 314-0756
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2023
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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