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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603344
Report Date: 02/01/2023
Date Signed: 02/01/2023 11:30:22 AM


Document Has Been Signed on 02/01/2023 11:30 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: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: 5DATE:
02/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Caregiver Irma Sunga and Assistant Administrator Jessi EnriquezTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPA was welcomed by and identified himself to Caregiver Irma Sunga. LPA then met and discussed the purpose of the visit with Assistant Administrator Jessi Enriquez, who arrived later during the visit.

LPA conducted a brief tour of the facility and spoke with staff. During the visit, 5 of 5 residents were off-site at a day program, and not present. In accordance with the Department’s Infection Control program, LPA provided technical assistance and observed and evaluated the facility's implementation of their COVID-19 Mitigation Plan, to include disinfection, screening protocols, and the use of personal protective equipment. No deficiencies were cited on this date.

An exit interview was conducted with Enriquez, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 02/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/01/2023
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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