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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603641
Report Date: 02/01/2021
Date Signed: 02/01/2021 03:05:43 PM

Document Has Been Signed on 02/01/2021 03:05 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:LA ESTANCIAFACILITY NUMBER:
374603641
ADMINISTRATOR:NELVA PINZONFACILITY TYPE:
740
ADDRESS:1946 LA CRESTA RDTELEPHONE:
(619) 334-4992
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY: 5CENSUS: 0DATE:
02/01/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Licensee, Nelva PinzonTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA), Alexandre Vo, conducted an unannounced closure virtual visit regarding a Licensee Initiated Closure by FaceTime. Virtual visits are being conducted due to COVID-19 restrictions. LPA met with Licensee, Nelva Pinzon, identified himself, and stated the purpose of the visit.

LPA received written notification of facility closure January 31st, 2021. During the visit, LPA conducted a virtual tour of the facility and confirmed that the one remaining resident has moved out of the facility. LPA retrieved the relocation information that resident had moved to another licensed community care facility. LPA requested the original licensee from Ms. Pinzon, who stated that it will be dropped off at the San Diego office as soon as possible. There were no deficiencies cited during the visit.

An exit interview was conducted. A copy of this report and Licensee's Rights (9058 01/16) were provided to the Licensee via electronic mail. An e-mail receipt confirms the acknowledgement of these documents.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Alexandre Vo
LICENSING EVALUATOR SIGNATURE: DATE: 02/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/01/2021
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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