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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600949
Report Date: 10/12/2021
Date Signed: 10/13/2021 02:40:59 PM

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:ANNE'S PLACE IIFACILITY NUMBER:
374600949
ADMINISTRATOR:ANNA OSBORNEFACILITY TYPE:
740
ADDRESS:2690 MARY LANE PLACETELEPHONE:
(760) 522-1989
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:6CENSUS: 5DATE:
10/12/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Licensee, Anna OsborneTIME COMPLETED:
02:35 PM
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Licensing Program Analysts (LPAs), Natasha Persaud and Kayla Hilario, and County of San Diego Nurse Contractor, Sandra Brackman, conducted an on-site visit. LPAs and Nurse identified themselves and discussed the purpose of the visit with Licensee, Anna Osborne and Manager, Dearme Doverte.

The Department conducted the on-site visit to provide technical assistance and to evaluate the facility's disinfection, screening protocols as well as the use of personal protective equipment. During today's visit, Licensee Osborne and Manager Doverte were interviewed and a walk-though of the facility was conducted. A debriefing was conducted with the Licensee and Manager at the conclusion of the visit. No deficiencies were issued today.

An exit interview was conducted with the Licensee and Manager and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to the Licensee via electronic mail. An electronic receipt of confirmation was requested to be sent by the Licensee upon receipt of the documents.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021
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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