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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602807
Report Date: 01/31/2025
Date Signed: 01/31/2025 01:26:16 PM

Document Has Been Signed on 01/31/2025 01:26 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:CLAIREMONT GUEST HOMEFACILITY NUMBER:
374602807
ADMINISTRATOR/
DIRECTOR:
ANDRADE, MAUREEN P.FACILITY TYPE:
740
ADDRESS:3476 IDLEWILD WAYTELEPHONE:
(858) 273-8845
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
01/31/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:50 AM
MET WITH:Caregiver Monina De GuzmanTIME VISIT/
INSPECTION COMPLETED:
01:35 PM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Required Annual Inspection visit. The LPA introduced himself and disclosed the purpose of the visit to Caregiver Monina De Guzman. The facility was licensed for a capacity of six (6) non-ambulatory residents. The facility also had an approved hospice waiver for six (6) residents.

During the visit, the LPA conducted a tour of the interior and exterior of the facility. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Doors, windows, screens, toilets, and showers were in working order. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, and meetings. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored.

Cooking equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled and stored in a locked area. No pools, nor bodies of water were observed on the premises. Per staff, no firearms, nor ammunition were kept at the facility. A carbon monoxide detector was tested, and a facility telephone and fire extinguisher were observed. Required licensing postings were also observed in visible areas of the facility.

The LPA conducted interviews and reviewed multiple staff and resident files. Technical Advise was provided and no deficiencies were cited during the annual inspection.

An exit interview was conducted Caregiver Monina De Guzman, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058), were provided.
Lizzette TellezTELEPHONE: (619) -76-2351
Sabel MartinezTELEPHONE: (619) 767-2301
DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2025
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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