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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601939
Report Date: 01/13/2025
Date Signed: 01/13/2025 03:59:36 PM

Document Has Been Signed on 01/13/2025 03:59 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:SPECIAL FRIENDS-SAGEWOODFACILITY NUMBER:
374601939
ADMINISTRATOR/
DIRECTOR:
WOJCIECHOWSKI, MICHELLEFACILITY TYPE:
735
ADDRESS:13411 SAGEWOOD DRIVETELEPHONE:
(858) 312-1687
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 6CENSUS: 5DATE:
01/13/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:House Manager, Ramily HernandezTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) David Roman conducted an unannounced Required Annual Continuation Inspection. LPA D. Roman was welcomed by, identified himself to, and discussed the purpose of the visit with House Manager, Ramily Hernandez. According to the facility’s license, the facility has a maximum capacity of 6 ambulatory developmentally disabled adults ages 18-59.

LPA toured the interior and exterior of the facility. One pool/bodies of water is located in the back yard of the premises fenced with 5 foot fence and locked. The facility was sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. There were no toxic chemicals/poisons accessible to residents. Water temperature was measured at 106 degrees F. Plan of correction was cleared as LPA D. Roman verified water temperature. Resident and Staff files were reviewed.

An exit interview was conducted with House Manager, Ramily Hernandez, to whom a copy of this report and the Licensee/Appeal Rights were provided during the visit.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: David Roman
LICENSING EVALUATOR SIGNATURE: DATE: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2025
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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