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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603643
Report Date: 06/04/2024
Date Signed: 06/04/2024 02:31:36 PM

Document Has Been Signed on 06/04/2024 02:31 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/
DIRECTOR:		STRATMAN, KIMFACILITY TYPE:
740
ADDRESS:1420 E PALOMAR STREETTELEPHONE:
(619) 591-0600
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY: 300CENSUS: 141DATE:
06/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Assistant Administrator Maria SanoTIME VISIT/
INSPECTION COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced Case Management visit to follow-up on an incident reported to Community Care Licensing. LPA met with Assistant Administrator Maria Sano, and discussed the purpose of the visit.

Community Care Licensing received an incident report on 4/15/24 in which it was reported that Resident #1 (R1) went absent without official leave (AWOL) from the facility on 4/13/24. R1 was found by a visitor on facility grounds outside near loading dock. R1 sustained a cut to her forehead, facility staff called 911 and R1 was transported to the hospital. R1 returned to the facility with no new orders. Per records reviewed licensee followed absentee notification plan as necessary. Facility conducted an elopement training for staff following the incident.

During today's visit, LPA conducted a health and safety check of the residents in care and provided consultation. No deficiencies were cited during today’s visit.

An exit interview was conducted with Sano who was also provided a copy of their appeal rights (LIC9058 03/22), LIC811, this report and their signature on this form, acknowledges receipt of these rights.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Alyssa Ramirez
LICENSING EVALUATOR SIGNATURE: DATE: 06/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/04/2024
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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