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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602043
Report Date: 07/13/2022
Date Signed: 07/13/2022 09:28:12 AM

Document Has Been Signed on 07/13/2022 09:28 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:G & L CARE HOME IIFACILITY NUMBER:
374602043
ADMINISTRATOR:LERMA M. BARBONFACILITY TYPE:
735
ADDRESS:6377 JOUGLARD STREETTELEPHONE:
(619) 434-2492
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY: 6CENSUS: 5DATE:
07/13/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:59 AM
MET WITH:Lerma BarbonTIME COMPLETED:
09:33 AM
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Licensing Program Analyst (LPA) Ramon Serrano and County of San Diego Public Health Nurse Elizar Perez conducted an on-site HAI assessment visit. LPA Serrano and team identified themselves and discussed the purpose of the visit with Licensee Lerma Barbon.

The Department conducted an on-site visit to provide technical assistance and to evaluate the facility's mitigation plan to include disinfection, testing, vaccination, and screening protocols as well as the use of personal protective equipment (PPE). During today's visit, LPA Serrano and Nurse Elizar Perez conducted a walk-though of the facility. A debriefing was conducted with Lerma Barbon at the conclusion of the visit.

No deficiencies were cited during today's visit. An exit interview was conducted with Lerma Barbon and a copy of this report along with Licensee Rights (LIC 9098, 01/16) was provided to Lerma Barbon whose signature below verifies receipt of these rights.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2022
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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