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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602441
Report Date: 12/15/2022
Date Signed: 12/15/2022 11:35:01 AM

Document Has Been Signed on 12/15/2022 11:35 AM - 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: 55DATE:
12/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Administrator Melinda WilliamsTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Kayla Hilario, conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit to Administrator Melinda Williams. All staff present have a current criminal record clearance.

LPA conducted a tour of the facility, both inside and outside and observed the clients in care. In accordance with the Department’s Infection Control, LPA provided technical assistance, evaluated, and observed the facility's implementation of their mitigation plan to include disinfection, testing surveillance, and screening protocols as well as the use of personal protective equipment. The facility has 55 enrolled clients however, no more than 33 clients are in-person at the facility at one time.

No deficiencies were cited or observed on this date.

An exit interview was conducted with Administrator Melinda Williams. A copy of this report and appeal rights (LIC9058 03/22), were provided via hardcopy at the conclusion of the visit.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Kayla Hilario
LICENSING EVALUATOR SIGNATURE: DATE: 12/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/15/2022
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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