<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603707
Report Date: 03/08/2024
Date Signed: 03/08/2024 11:38:19 AM

Document Has Been Signed on 03/08/2024 11:38 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:KOSTER ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
374603707
ADMINISTRATOR:KOSTER EDWINA JOFACILITY TYPE:
735
ADDRESS:1598 SOMA PLTELEPHONE:
(619) 442-3159
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY: 4CENSUS: DATE:
03/08/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:TIME COMPLETED:
10:00 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Liliana Silveira made an attempt to conduct an unannounced visit to complete a required annual licensing inspection. Upon arrival to the facility, LPA made attempts to contact the Licensee to no avail. LPA approached the facility, rang the doorbell and knocked on the front door entrance. There was no answer. LPA also called the facility phone number on file and the Licensee phone number, however, there was no answer.

LPA called Licensee Edwina Koster and left a phone message with contact information. LPA will return at a later date to conduct the annual inspection.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1