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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602352
Report Date: 10/05/2021
Date Signed: 10/05/2021 12:53:40 PM

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:AERIE MEADOWS CARE HOMEFACILITY NUMBER:
374602352
ADMINISTRATOR:LILLIAN MENZIEFACILITY TYPE:
740
ADDRESS:5610 DEHESA ROADTELEPHONE:
(619) 659-1577
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY:6CENSUS: 0DATE:
10/05/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:26 AM
MET WITH:Lilian MenzieTIME COMPLETED:
01:12 PM
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Licensing Program Analyst (LPA) Kennedy conducted an unannounced visit to verify the facility has no residents as part of the facility closing process. LPA met with the Licensee Lilian Menzie, and discussed the purpose of the visit. LPA toured the facility with the Licensee and found no evidence of individuals in residence. Licensee provided the LPA with the license.

No violations were cited during the visit.

An exit interview was conducted with Lilian Menzie, Licensee. A copy of this report along with Licensee Rights (LIC9058 01/2016) was provided to Ms. Menzie via email. An electronic response confirms the documents were received.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Anna KennedyTELEPHONE: (619) 997- 4108
LICENSING EVALUATOR SIGNATURE:

DATE: 10/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021
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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