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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603228
Report Date: 03/20/2024
Date Signed: 03/20/2024 05:04:29 PM

Document Has Been Signed on 03/20/2024 05:04 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:RB SENIOR RESIDENCES IIFACILITY NUMBER:
374603228
ADMINISTRATOR:COOK, CHERRYFACILITY TYPE:
740
ADDRESS:15158 JENELL STREETTELEPHONE:
(858) 883-2180
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 6CENSUS: 4DATE:
03/20/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:56 PM
MET WITH:Caregiver Casey Villas and Administrator Kathleen MarquezTIME COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) Juliana Barfield conducted an unannounced continuation visit for a Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to and discussed the purpose of the visit with Casey Villas. Administrator Kathleen Marquez shortly arrived at the facility.

During today’s visit, LPA briefly toured the facility and reviewed facility files. No deficiencies were cited during today’s visit. Due to time constraints, a return visit on a subsequent day is needed to complete the annual inspection.

An exit interview was conducted with the Marquez, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.


SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Juliana Barfield
LICENSING EVALUATOR SIGNATURE: DATE: 03/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/20/2024
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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