<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602179
Report Date: 05/24/2023
Date Signed: 05/24/2023 02:21:29 PM

Document Has Been Signed on 05/24/2023 02:21 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:TENDER LOVING CARE GUEST HOMEFACILITY NUMBER:
374602179
ADMINISTRATOR:VICTORIA S. LEGASPIFACILITY TYPE:
740
ADDRESS:1430 SHERYL LNTELEPHONE:
(619) 399-3552
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY: 6CENSUS: 5DATE:
05/24/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Victoria Legaspi, AdministratorTIME COMPLETED:
02:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced case management visit at the facility. LPA Lopez identified herself and was granted entry by Victoria Legaspi, Administrator. LPA stated the purpose of the visit and reviewed the basic elements of the case management visit with Administrator Legaspi.

During a complaint investigation, it was discovered that resident #1 (R1) would leave the facility unassisted. According to the R1’s Physician’s Report, R1 is not allowed to leave the facility unassisted. Per the Administrator, R1’s records need to be updated to reflect R1 is able to leave the facility unassisted. R1 returns to the facility that same day when R1 is out in the community. R1 is able to transport in the community on their own. Per Administrator, R1’s responsible party is aware and purchases their transportation pass.

No deficiencies were cited during this visit, but a Technical Assistance (LIC9102) notice was provided to the Administrator.

An exit interview was conducted with Administrator Legaspi and a copy of this report, LIC 811 and Licensee/Appeal Rights (LIC 9058 01/16) were provided to the Administrator at the conclusion of the visit. The signature below confirms the documents were received.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1