<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600904
Report Date: 01/10/2022
Date Signed: 01/10/2022 02:01:28 PM

Document Has Been Signed on 01/10/2022 02:01 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:L & M RESIDENTIALFACILITY NUMBER:
374600904
ADMINISTRATOR:LARA, OSCARFACILITY TYPE:
735
ADDRESS:2840 VIA DEL ALLAZONTELEPHONE:
(619) 267-4955
CITY:BONITASTATE: CAZIP CODE:
91902
CAPACITY: 4CENSUS: 4DATE:
01/10/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Oscal LaraTIME COMPLETED:
02:41 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Kennedy conducted a case management visit due to a request to change the facility capacity. LPA Identified herself and met with Oscar Lara, Licensee and Administrator and discussed the purpose of the visit.

Licensee is requesting a change from a facility capacity of 4 ambulatory clients to a capacity of 6 with 4 ambulatory and 2 nonambulatory clients.

CCL received an approved fire clearance from the Bonita Fire Department dated 01-05-22.

During the visit LPA toured the facility and observed accommodations for all clients.

Based on LPA observations and the fire clearance having been granted, LPA is recommending that the change in capacity be approved.

During today's visit, no deficiencies were cited.  An exit interview was conducted with the Oscar Lara. A copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to Mr. Lara via electronic mail.  An electronic receipt of confirmation was requested upon receipt of the documents.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Anna Kennedy
LICENSING EVALUATOR SIGNATURE: DATE: 01/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1