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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601126
Report Date: 12/08/2023
Date Signed: 12/08/2023 01:06:34 PM

Document Has Been Signed on 12/08/2023 01:06 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:BMJ RESIDENTIAL CARE HOMEFACILITY NUMBER:
374601126
ADMINISTRATOR:MARILYN B. JIMENEZFACILITY TYPE:
735
ADDRESS:1006 CHESTNUT DRIVETELEPHONE:
(760) 690-2443
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY: 6CENSUS: 4DATE:
12/08/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:14 PM
MET WITH:Staff, Anita DugueTIME COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Janira Arreola made an unannounced visit to the facility in order to conduct a case management. LPA met with Staff, Anita Dugue who was informed of the purpose of the visit.

LPA conducted a health and safety check of the residents in care. One (1) resident was present during the time of the visit, and (3) staff. Per staff, remaining (3) residents were at their day program. LPA conducted interview, gathered documents and conducted a walk through of the home. No health or safety issues were observed during the time of the visit. At this time the department will evaluate information gathered on incident report. Additional visits or phone calls may be necessary.

No deficiencies were cited during the time of the visit. An exit interview was conducted with Staff, Anita Dugue where this report was reviewed and provided to them.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2023
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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