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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602941
Report Date: 02/22/2022
Date Signed: 02/22/2022 02:51:45 PM

Document Has Been Signed on 02/22/2022 02:51 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:HJJ HOME #1FACILITY NUMBER:
374602941
ADMINISTRATOR:BOYER, HOWARD D.FACILITY TYPE:
735
ADDRESS:28441 MEADOW GLEN WAY WESTTELEPHONE:
(760) 580-8575
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY: 6CENSUS: 4DATE:
02/22/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Licensee Howard BoyerTIME COMPLETED:
01:50 PM
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On 2/22/2022, at 1:25 p.m., Licensing Program Analyst (LPA) Sabel Martinez conducted a case management visit. LPA identified himself to the Licensee, Howard Boyer, and discussed the purpose of the visit.

A Change of Capacity application was received by Community Care Licensing (CCL), in which the licensee requested a decrease in capacity from 6 to 4 clients. The Fire Safety Inspection Request was approved by the local fire authority on February 16, 2022.

During today's visit, a tour of the facility was conducted. No immediate health and/or safety concerns were observed. The facility sketch/floor plan was consistent with the current layout. Client rooms and accommodations were observed to be appropriate.

The completed change of capacity request will be forwarded to management for final review and approval. Approval notification to licensee will be made by Community Care Licensing, and a new license will be mailed to the licensee after final approval.

An exit interview was conducted with Licensee, Howard Boyer. A copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) wwre provided to the licensee via Electronic mail. A read receipt confirms these documents were received by the licensee.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2022
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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