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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603344
Report Date: 01/04/2022
Date Signed: 01/04/2022 02:27:52 PM

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:A WINSOME ASSISTED LIVING COMMUNITYFACILITY NUMBER:
374603344
ADMINISTRATOR:GUIA IGBANTE-ENRIQUEZFACILITY TYPE:
740
ADDRESS:3808 SWEETWATER ROADTELEPHONE:
(619) 434-6560
CITY:BONITASTATE: CAZIP CODE:
91902
CAPACITY:6CENSUS: 6DATE:
01/04/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
12:54 PM
MET WITH:Guia Igbante - EnriquezTIME COMPLETED:
03:10 PM
NARRATIVE
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Licensing Program Analyst (LPA) Kennedy and County of San Diego Nurse Contractor, Elizar Perez with the HAI Program, conducted an on-site HAI assessment visit. LPA and nurse identified themselves and discussed the purpose of the visit with Guia Igbante-Enriquez, Licensee and Administrator.

The Department conducted an on-site visit to provide technical assistance and to evaluate the facility's mitigation plan to include disinfection, testing, vaccination, and screening protocols as well as the use of personal protective equipment (PPE). During today's visit, the team interviewed the Licensee and Guia Igbante-Enriquez and conducted a walk-though of the facility. A debriefing was conducted at the conclusion of the visit.

During today's visit, no deficiencies were cited.  An exit interview was conducted with the Guia Igbante-Enriquez. A copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to Ms. Igbante-Enriquez via electronic mail.  An electronic receipt of confirmation was requested upon receipt of the documents.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Anna KennedyTELEPHONE: (619) 997- 4108
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2022
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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