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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602961
Report Date: 10/11/2022
Date Signed: 10/12/2022 08:47:10 AM

Document Has Been Signed on 10/12/2022 08:47 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:BEARING LANE HOME CAREFACILITY NUMBER:
374602961
ADMINISTRATOR:JENKINS, VALERIEFACILITY TYPE:
735
ADDRESS:190 BEARING LANETELEPHONE:
(619) 749-4629
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY: 4CENSUS: 4DATE:
10/11/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Assistant Administrator Suzanne EvansTIME COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced case management visit to follow-up on an incident reported to Community Care Licensing. LPA met with Assistant Administrator Suzanne Evans, and discussed the purpose of the visit, Licensee Valerie Jenkins arrived shortly after.

Community Care Licensing received an incident report on 10/10/2022 in which it was reported that Client #1 (C1) went absent without official leave (AWOL) from the facility on 10/3//2022 and returned on 10/4/2022. Per records reviewed licensee followed absentee notification plan as necessary.

During today's visit, LPA conducted a health and safety check of the clients in care and provided consultation. No deficiencies were cited during today’s visit.

Licensee Valerie Jenkins was provided a copy of this report, appeal rights (LIC9058 03/22) and a LIC 811.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2022
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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