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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601175
Report Date: 06/05/2024
Date Signed: 06/05/2024 09:18:00 AM

Document Has Been Signed on 06/05/2024 09:18 AM - 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:DSC, INC. - BUENA VALLEY HOUSEFACILITY NUMBER:
374601175
ADMINISTRATOR/
DIRECTOR:		DIANE SPURGEONFACILITY TYPE:
735
ADDRESS:1787 DUPONT DRIVETELEPHONE:
(619) 460-7333
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY: 3CENSUS: DATE:
06/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Care Giver Marshell GibsonTIME VISIT/
INSPECTION COMPLETED:
09:15 AM
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Licensing Program Analysts (LPA) Amy Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Care Giver Marshell Gibson.,

According to the facility’s license, the facility has a maximum capacity of three (3) clients, all of whom are all ambulatory. This facility does not feature a secured perimeter or delayed egress doors.

During today’s visit, LPA briefly toured the facility and and spoke with care Giver Marshell Gibson and will need to return at a later date. No deficiencies were cited during todays visit.

An exit interview was conducted with the Care Giver Marshell Gibson to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided. .



SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE: DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2024
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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