<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602850
Report Date: 04/29/2022
Date Signed: 04/29/2022 10:07:48 AM

Document Has Been Signed on 04/29/2022 10:07 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:WENDY'S GUEST HOMEFACILITY NUMBER:
374602850
ADMINISTRATOR:WENDY ENGLE, CLINT ENGLEFACILITY TYPE:
735
ADDRESS:1592 E WASHINGTON AVENUETELEPHONE:
(619) 328-0890
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY: 4CENSUS: 4DATE:
04/29/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:Thomas Arlington, CaretakerTIME COMPLETED:
10:20 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced case management visit to check on the health and safety of residents in care. LPA identified herself and was granted access to the facility by Thomas Arlington, caretaker. LPA met with caretaker Arlington and discussed the purpose of the visit. LPA spoke with Licensee Wendy Engle via mobile telephone.

The visit was initiated due to a self reported incident involving client #1, that was reported to Licensee on April 20, 2022. The incident was reported to Community Care Licensing (CCL) via form Special Incident Report, which was received by the Regional Office on April 22, 2022.

During today’s visit, LPA briefly spoke with staff and client, and requested and obtained relevant documents maintained by the facility. No immediate health and/or safety concerns were observed.

An exit interview was conducted with caretaker Arlington and Licensee Engle. A copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) was provided to the facility. The signature below confirms receipt of these documents.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1