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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600904
Report Date: 12/15/2023
Date Signed: 12/15/2023 03:40:03 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 12/15/2023 03:40 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: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:
12/15/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Licensee, Oscar LaraTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA identified herself and was granted entry by Administrator, Oscar Lara and explained the reason for the visit.

Community Care Licensing conducted a full annual inspections on 8/11/2023, no violations were noted.

During today's visit, LPA conducted a quick tour of the facility and conducted staff interviews. Three out of the four clients were out in the community attending day program. LPA briefly interacted with client in the facility. Interviews with staff and client did not raise any concerns.

No violations were noted during today/s visit.

The Licensee was provided a copy of her appeal rights (LIC9058 01/16). An exit interview was conducted with Administrator, Oscar Lara, and a copy of this report was provided at the end of the visit.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2023
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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