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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602666
Report Date: 10/24/2024
Date Signed: 10/24/2024 03:45:02 PM

Document Has Been Signed on 10/24/2024 03:45 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:APK SERENE, KERNFACILITY NUMBER:
374602666
ADMINISTRATOR/
DIRECTOR:		LINDA GRUBBFACILITY TYPE:
735
ADDRESS:19 KERN CTTELEPHONE:
(760) 722-2757
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY: 5CENSUS: 3DATE:
10/24/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:25 PM
MET WITH:Caregiver Princess PayangaTIME VISIT/
INSPECTION COMPLETED:
03:55 PM
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Licensing Program Analyst (LPA) Rebecca Ruiz and Licensing Program Manager (LPM) Jennifer Lott conducted an unannounced Case Management - Health Checks visit in coordination with San Diego Regional Center. LPA and LPM were greeted by, identified themselves to, and discussed the purpose of the visit with Caregiver Princess Payanga.

During today's visit, LPA and LPM briefly toured the facility and spoke with staff. In coordination with San Diego Regional Center staff, LPA and LPM oversaw and verified that the three (3) clients in care were safely moved out of the facility, along with their current medications, basic client records, Personal and Incidental (P&I) monies, and essential clothing and belongings.

No deficiencies were observed or cited during today's visit. An exit interview was conducted with Caregiver Princess Payanga, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 10/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/24/2024
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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