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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602248
Report Date: 07/14/2022
Date Signed: 07/14/2022 12:35:21 PM

Document Has Been Signed on 07/14/2022 12:35 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:LUCY'S HOMEFACILITY NUMBER:
374602248
ADMINISTRATOR:LUCY ANTHONYFACILITY TYPE:
735
ADDRESS:4979 GOLF GLEN ROADTELEPHONE:
(619) 267-7244
CITY:BONITASTATE: CAZIP CODE:
91902
CAPACITY: 4CENSUS: 4DATE:
07/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Jose Lopez, House ManagerTIME COMPLETED:
12:37 PM
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Licensing Program Analyst (LPA) Daniela Huerta visited the facility to conduct an annual required licensing inspection. LPA disclosed the purpose of the visit, was granted entry into the facility, and met with Jose Lopez, House Manager.

During today’s visit, LPA toured the facility and verified compliance with infection control practices. LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff, residents, and visitors; a sign-in policy enacted for visitors; signs in the facility to promote hand hygiene, cough/sneeze etiquette, symptom and transmission awareness; face coverings worn by staff; hand sanitizer/hand washing stations readily available; and an ample supply of cleaning products.

No deficiencies were cited during today’s visit. An exit interview was conducted with Jose Lopez, and a copy of this report and Licensee Rights (LIC 9058 FAS 01/16) was provided.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniela Huerta
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2022
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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