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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602712
Report Date: 02/22/2021
Date Signed: 03/11/2021 04:58:28 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:ANNE'S PLACE IVFACILITY NUMBER:
374602712
ADMINISTRATOR:ANA OSBORNEFACILITY TYPE:
740
ADDRESS:2870 WANEK ROADTELEPHONE:
(760) 233-5878
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY:10CENSUS: 9DATE:
02/22/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Administrator Ana OsborneTIME COMPLETED:
12:37 PM
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THIS IS AN AMENDED REPORT OF A VISIT CONDUCTED: 2/2/21.

Licensing Program Analyst (LPA) Silveira contacted the facility via telephone regarding a Case Closure. The visit was conducted virtually through FaceTime due to COVID-19. LPA identified themselves and explained the purpose of the visit to Administrator Ana Osborne.

During the call, no visual indications suggested that Staff #1 (S1, see List of Confidential Names) was present at the facility. A cursory tour of the facility was conducted.

Per interview with Administrator, Administrator clarified that when she spoke to the SDRO Duty Officer on 01/08/21, she confused the name of S1 with another staff with a similar name who currently works at the facility. Administrator stated that S1 was never hired at the facility and has never worked at the facility.

No deficiencies were observed on this date.

An exit interview was conducted via telephone, and a copy of this report and Licensee's Rights (9058 01/16) were e-mailed to the Administrator. A confirmation of receipt was requested to be sent back by the Administrator.




SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (610) 301-9770
LICENSING EVALUATOR NAME: Denise PowellTELEPHONE: (619) 314-0756
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2021
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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