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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603707
Report Date: 03/21/2024
Date Signed: 03/25/2024 10:36:46 AM

Document Has Been Signed on 03/25/2024 10:36 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: 2DATE:
03/21/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
05:00 PM
MET WITH:Licensee Edwina FosterTIME COMPLETED:
05:45 PM
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 conducted an unannounced visit to conduct a health and safety check. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Licensee Edwina Koster.

During today’s visit, LPA briefly toured the facility and spoke to Licensee. LPA did not observe anything of concern. No deficiencies were cited during today’s visit.

An exit interview was conducted with Edwina, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE: DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/21/2024
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