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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603533
Report Date: 09/06/2023
Date Signed: 09/06/2023 02:03:01 PM

Document Has Been Signed on 09/06/2023 02:03 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:WORK SKILL RESOURCESFACILITY NUMBER:
374603533
ADMINISTRATOR:ENUNWA, EBELEFACILITY TYPE:
775
ADDRESS:9349 JAMACHA BLVDTELEPHONE:
(619) 512-1107
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY: 60CENSUS: 55DATE:
09/06/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Tracy McKnight, Assistant AdministratorTIME COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced collateral visit to conduct interviews relative to complaints lodged against other licensed facilities. LPA was granted entry and conducted interviews with program consumers who reside in Adult Residential Facilities licensed by the Department.

No deficiencies were observed or cited during the visit.

An exit interview was conducted with Tracy McKnight, Assistant Administrator, and copies of this report and Licensee Rights were provided to Ms. McKnight at the conclusion of the visit.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2023
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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