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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602441
Report Date: 09/01/2021
Date Signed: 09/01/2021 05:31:50 PM

Document Has Been Signed on 09/01/2021 05:31 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:SAM & ROSE STEIN EDUCATION CENTERFACILITY NUMBER:
374602441
ADMINISTRATOR:PONCE, SERGIOFACILITY TYPE:
775
ADDRESS:4990 WILLIAMS AVETELEPHONE:
(619) 463-3300
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY: 45CENSUS: 51DATE:
09/01/2021
TYPE OF VISIT:Case Management - COVID-19ANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Program Director, Joanne GarciaTIME COMPLETED:
03:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno, County of San Diego Senior Public Health Nurses, Jennifer West and Elizar Perez, conducted an in-person visit. All staff present at the facility had a current criminal record clearance.

LPA and team identified themselves and discussed the purpose of the visit with Program Director, Joanne Garcia and Administrator, Melinda Williams.

The Department conducted an on-site visit to provide technical assistance and to evaluate the facility's disinfection and screening protocols. During today's visit, the team interviewed the Administrator and provided consultation and conducted a walk-though of the facility. A debriefing was conducted with the Director and Administrator at the conclusion of the visit.

During today's visit, no deficiencies were issued. An exit interview was conducted with Program Director, Garcia, and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to the Director via electronic mail. An electronic receipt of confirmation was requested to be sent by the Director upon receipt of the documents.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE: DATE: 09/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/01/2021
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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