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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600919
Report Date: 05/06/2021
Date Signed: 05/06/2021 11:48:23 AM

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:SIENA HOME CAREFACILITY NUMBER:
374600919
ADMINISTRATOR:LIMPIN, ALEXANDERFACILITY TYPE:
740
ADDRESS:415 S. SIENA STREETTELEPHONE:
(619) 472-5912
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY:6CENSUS: 4DATE:
05/06/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:28 AM
MET WITH:Lina Diaz, CaregiverTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Lizzette Tellez conducted an unannounced case management visit, via telephone due to COVID-19, to check on the health and safety of residents in care. LPA identified herself to Caregiver, Lina Diaz, and discussed the purpose of the visit.

During today's televisit, LPA toured the facility and observed residents in care. No immediate health and/or safety concerns were observed during the visit.

No deficiencies were issued during today's visit. An exit interview was conducted with Ms. Diaz and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to the Administrator via electronic mail. An electronic receipt of confirmation was requested to be sent by the Administrator upon receipt of the documents.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Lizzette TellezTELEPHONE: (619) 219-9755
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2021
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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