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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603387
Report Date: 03/22/2024
Date Signed: 03/22/2024 11:42:26 AM

Document Has Been Signed on 03/22/2024 11:42 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:COLES RESIDENTIAL CAREFACILITY NUMBER:
374603387
ADMINISTRATOR:VICKI COLESFACILITY TYPE:
735
ADDRESS:507 ALICE STTELEPHONE:
(760) 477-7395
CITY:RAMONASTATE: CAZIP CODE:
92065
CAPACITY: 2CENSUS: 0DATE:
03/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Administrator, Vicki ColesTIME COMPLETED:
11:50 AM
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 Licensing Program Manager (LPM) Lizzette Tellez and Licensing Program Analysts (LPAs) Juliana Barfield and Adrian Mangina conducted a case management visit. LPM and LPAs identified themselves to Administrator, Vicki Coles, with whom we discussed the purpose of the visit.

This visit was initiated due to the death of Client #1 (C1). Ms. Coles was provided with a Confidential Names Form in order to identify C1. A Death Report for C1 was received in the San Diego Regional Office on March 18, 2024.

During today's visit, LPM and LPAs toured the facility, interviewed staff, and obtained copies of C1's records. No immediate health and/or safety concerns were observed during the visit.

No deficiencies were cited during today's visit. An exit interview was conducted with Ms. Coles. A copy of this report along with Licensee Rights (LIC 9098 01/16) were provided to them at the conclusion of the visit.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Juliana Barfield
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2024
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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