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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602722
Report Date: 03/15/2024
Date Signed: 03/15/2024 01:34:51 PM

Document Has Been Signed on 03/15/2024 01:34 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:INDEPENDENCE FIRST, INC.-BUENA VISTAFACILITY NUMBER:
374602722
ADMINISTRATOR:AGUINALDO, LAIKAFACILITY TYPE:
735
ADDRESS:2519 BUENA VISTA AVETELEPHONE:
(619) 518-7375
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY: 6CENSUS: 4DATE:
03/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Licensee Laika Aguinaldo and Administrator Elsie Aguinaldo TIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Licensee Laika Aguinaldo and Administrator Elsie Aguinaldo.

Today's visit was in response to licensee’s self-reported death of Client #1 (C1), received at the CCLD San Diego Regional Office on 3/2/2024. [See LIC 811 Confidential Names List for a description of C1]. Per the report, C1 passed away on 3/2/2024.

LPA performed a facility tour of facility, collected pertinent records and interviewed relevant staff. All clients were at day program during the visit. No deficiencies were observed or cited during today's visit.

An exit interview was conducted with Licensee Laika Aguinaldo, to whom a copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE: DATE: 03/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/15/2024
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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