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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603381
Report Date: 06/02/2020
Date Signed: 06/02/2020 10:01:58 AM

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:HUMMINGBIRD HILLFACILITY NUMBER:
374603381
ADMINISTRATOR:CHRIS B. CONKLINFACILITY TYPE:
740
ADDRESS:1027 CALLE DE LIMARTELEPHONE:
(760) 723-9414
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY:5CENSUS: 0DATE:
06/02/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Chris Conklin, AdministratorTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Jonathan Pineda contacted the facility via facetime to conduct a case management due to COVID-19. LPA identified himself and discussed the purpose of the face time call with Chris Conklin, Administrator.

During today's tele-visit, LPA toured the facility and observed the capacity change to one (1) bedridden client. Fire clearance was approved on 5/14/20; one (1) ambulatory resident, three (3) non-ambulatory residents, and one (1) bedridden resident.

No deficiency noted during today's tele-visit.

An exit interview was conducted with Chris Conklin, Administrator and a copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) was provided via email. An electronic email read receipt confirms the documents were received.
SUPERVISOR'S NAME: Tony GirolamiTELEPHONE: (619) 767-2301
LICENSING EVALUATOR NAME: Jonathan C PinedaTELEPHONE: (619) 481-0846
LICENSING EVALUATOR SIGNATURE:

DATE: 06/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2020
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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