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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601685
Report Date: 08/02/2021
Date Signed: 08/02/2021 11:04:44 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:REGENCY FALLBROOKFACILITY NUMBER:
374601685
ADMINISTRATOR:RIDENOUR, JASMINEFACILITY TYPE:
740
ADDRESS:609 E.ELDER STREETTELEPHONE:
(760) 728-8504
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY:75CENSUS: 54DATE:
08/02/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:37 AM
MET WITH:Wellness Director, Kari MorenoTIME COMPLETED:
10:57 AM
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Licensing Program Analyst (LPA), Kristina Ryan, initiated an unannounced case management visit to conduct a health and safety check and review COVID-19 mitigation strategies. The virtual visit was conducted via FaceTime due to COVID-19 restrictions. LPA met with Wellness Director, Kari Moreno, identified herself, and stated the purpose of the virtual visit.

During today's visit, LPA toured the facility and interviewed the Wellness Director, Kari Moreno. No deficiencies were issued during this visit.

An exit interview was conducted. A copy of this report and Licensee's Rights (9058 01/16) were provided to the Kari Moreno via electronic mail. An email receipt confirms the acknowledgement of these documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Kristina RyanTELEPHONE: (619) 929-1438
LICENSING EVALUATOR SIGNATURE:

DATE: 08/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2021
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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