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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602991
Report Date: 09/14/2022
Date Signed: 09/14/2022 11:05:54 AM


Document Has Been Signed on 09/14/2022 11:05 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:VERDUGO BOARDING HOMEFACILITY NUMBER:
374602991
ADMINISTRATOR:JACOME, RIGOBERTO GARCIAFACILITY TYPE:
740
ADDRESS:690 HELEN DRIVETELEPHONE:
(760) 757-8403
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:6CENSUS: 6DATE:
09/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Rigoberto GarciaTIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced case management visit based on observations during a case management visit on 9/14/2022. LPA was greeted by, identified herself to, and discussed the purpose of the visit with Administrator Rigoberto Garcia.

During today's visit, LPA toured the facility and spoke with staff and residents. LPA provided consultation regarding regulations on video and audio surveillance with Administrator Rigoberto Garcia.

No deficiencies were cited on this date. An exit interview was conducted with Rigoberto Garcia, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) were provided via hard copy.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Rebecca A RuizTELEPHONE: (619) 318-7620
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2022
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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