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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602052
Report Date: 10/20/2020
Date Signed: 10/20/2020 11:40:36 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:OLIVENHAIN GUEST HOMEFACILITY NUMBER:
374602052
ADMINISTRATOR:KAREN KANANFACILITY TYPE:
740
ADDRESS:350 COLE RANCH ROADTELEPHONE:
(760) 753-5082
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:42CENSUS: 29DATE:
10/20/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Administrator, Karen KananTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA), Natasha Persaud, contacted the facility via telephone regarding a Criminal Record Exemption. The visit is being conducted via telephone due to COVID-19. LPA identified herself and explained the purpose of the call to Administrator, Karen Kanan.

During the call, visual conference with the Administrator, LPA briefly toured the facility and interviewed staff. LPA explained Staff #1(S1) requires a Criminal Record Exemption. Administrator verified that S1 was not on site.

Per the Administrator, S1 was hired on July 2020 as a cook and terminated on 08/29/20. The facility is pursuing an exemption request for S1. Administrator is aware S1 is not allowed on the premises and may not return prior to an approved exemption. No deficiencies were issued.

An exit interview was conducted with Karen Kanan, Administrator, via virtual visit, and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided to the Administrator via electronic mail. An electronic read receipt confirmation was requested to be sent by the Administrator upon receipt of the documents. [See LIC 811 Confidential Names List to identify Staff #1]
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2020
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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