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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603729
Report Date: 08/31/2021
Date Signed: 08/31/2021 05:00:49 PM

Document Has Been Signed on 08/31/2021 05:00 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:ESPERANZA CRISIS CENTERFACILITY NUMBER:
374603729
ADMINISTRATOR:BERTELLE, LISAFACILITY TYPE:
772
ADDRESS:490 N GRAPE STTELEPHONE:
(619) 275-0822
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY: 16CENSUS: 13DATE:
08/31/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Rebecca Westfall, Program DirectorTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Carmen Lopez, and County of San Diego Public Health Nurses Robert Montillano, Registered Nurse with the HAI Program, and Sandra Brackman, Registered Nurse with the HAI Program, conducted an on-site HAI assessment visit. LPA and team identified themselves and discussed the purpose of the visit with Rebecca Westfall, Program Director.

The Department conducted an on-site visit to provide technical assistance and to evaluate the facility's mitigation plan to include disinfection, testing, vaccination, and screening protocols as well as the use of personal protective equipment (PPE). During today's visit, the team interviewed the Rebecca Westfall, Program Director and the team conducted a walk-though of the facility. A debriefing was conducted with Program Director Westfall at the conclusion of the visit.

During today's visit, no deficiencies were cited. An exit interview was conducted with Rebecca Westfall, Program Director and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to Program Director via electronic mail. An electronic receipt of confirmation was requested to be sent by Program Director Westfall upon receipt of the documents.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2021
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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