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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601435
Report Date: 01/29/2021
Date Signed: 02/09/2021 11:33:34 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:SANTA MARTHA RESIDENTIALFACILITY NUMBER:
374601435
ADMINISTRATOR:KELLY, FLORA MFACILITY TYPE:
740
ADDRESS:3739 MILLIKIN AVETELEPHONE:
(858) 999-0278
CITY:SAN DIEGOSTATE: CAZIP CODE:
92122
CAPACITY:0CENSUS: 6DATE:
01/29/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Flora Kelly, LicenseeTIME COMPLETED:
10:10 AM
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Licensing Program Analyst (LPA), Laarni Santiago, conducted virtual visit regarding facility closure due to a Change of Ownership. Virtual visits are being conducted due to COVID-19 restrictions and was completed via Zoom. LPA contacted Licensee, Flora Kelly and Administrator, Kevin Posada. LPA identified herself and stated the purpose of the call.

During today's call, LPA briefly toured the facility and verified the residents' placement. No residents were relocated and they were visually verified on the call. LPA requested the original license from the Administrator who stated that it was sent to the Sacramento office.

An exit interview was conducted, and a copy of this report and Licensee's Rights (9058 01/16) were provided to the Administrator via electronic mail. An e-mail receipt confirms the acceptance of these documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 318-5974
LICENSING EVALUATOR NAME: Laarni SantiagoTELEPHONE: (619) 318-5974
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2021
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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