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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603643
Report Date: 10/06/2022
Date Signed: 10/06/2022 03:56:59 PM

Document Has Been Signed on 10/06/2022 03:56 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
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:ST. PAUL'S PLAZAFACILITY NUMBER:
374603643
ADMINISTRATOR:STRATMAN, KIMFACILITY TYPE:
740
ADDRESS:1420 E PALOMAR STREETTELEPHONE:
(619) 591-0600
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY: 300CENSUS: 214DATE:
10/06/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:14 PM
MET WITH:Kim Stratman, AdministratorTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Renita Hall and Licensing Program Analyst Riza Alvarez conducted an
unannounced Case Management visit. LPA's met with Kim Stratman, Administrator , and we discussed the purpose
of the visit.

Today's visit is to follow up on the self reported death of Client 1 (R1 - See LIC 811 Confidential Names List).
R1 passed away at the hospital on 10/01/2022 LPA obtained additional information on this date.
In addition, LPA conducted a Health and Safety visit on clients in care. Staff present had a
current criminal record clearance. Clients observed by the LPA appeared appropriate for the
facility.

No deficiencies were cited or observed on this date.

The Licensee was provided a copy of her appeal rights (LIC 9058 03/22), and her signature on this form,
acknowledges receipt of these rights. An exit interview was conducted and a copy of this report was provided
to Kim Stratman, Administrator
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE: DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/06/2022
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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