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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603714
Report Date: 06/24/2020
Date Signed: 06/24/2020 04:55:26 PM

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:ACTIVCARE AT 4S RANCHFACILITY NUMBER:
374603714
ADMINISTRATOR:ASHLEY PEARCEFACILITY TYPE:
740
ADDRESS:10603 RANCHO BERNARDO ROADTELEPHONE:
(858) 485-8001
CITY:SAN DIEGOSTATE: CAZIP CODE:
92127
CAPACITY:60CENSUS: 41DATE:
06/24/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:55 PM
MET WITH:Ashley Pearce, AdministratorTIME COMPLETED:
04:55 PM
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Licensing Program Analyst (LPA) Laarni Santiago conducted an unannounced tele-virtual site visit to the facility to follow up on a confirmation of removal notification. LPA spoke with Ashley Pearce, Administrator and Christie Ruiz, Business Manager and advised them on the purpose of this tele-visit.

A notification letter dated May 26, 2020 was generated to notify the licensee that Staff 1 (S1) (See LIC 811 Confidential Names.) has non-exemptible conviction. On this day, LPA verified and confirmed that this individual was hired on May 22, 2020 after the facility received a clearance from the Department of Justice. Interviews revealed that S1 only worked on 05/25/20 and 05/26/20 to conduct computer training. However, upon receipt of the non-exemptible conviction, S1 was terminated on 05/27/20. LPA was provided a copy of the confirmation of removal response on 05/27/20. LPA requested for facility documentation to verify S1's termination information.

Based on evidence obtained during today’s visit, the LPA has verified that S1 is not present, employed or residing at the facility.

An exit interview was conducted with Administrator, Ashley Pearce, who was provided a copy of the report via email. An electronic email read receipt confirms the documents were received.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 318-5974
LICENSING EVALUATOR NAME: Laarni SantiagoTELEPHONE: (619) 318-5974
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2020
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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