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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603734
Report Date: 05/04/2022
Date Signed: 06/09/2022 03:16:52 PM

Document Has Been Signed on 06/09/2022 03:16 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:SHINING STAR ADULT DAY CARE INCFACILITY NUMBER:
374603734
ADMINISTRATOR:GRIGGS, LAURA CASASFACILITY TYPE:
775
ADDRESS:333 E STREETTELEPHONE:
(619) 651-7446
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 30CENSUS: 30DATE:
05/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:48 AM
MET WITH:Laura Casas Griggs TIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Ramon Serrano, conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPA met with Director Laura Casas Griggs and discussed the purpose of the visit. All staff present have a current criminal record clearance.

LPA conducted a tour of the facility, both inside and outside and observed the clients in care. In accordance with the Department’s Infection Control, LPA provided technical assistance, evaluated, and observed the facility's implementation of their mitigation plan to include disinfection, testing surveillance, and screening protocols as well as the use of personal protective equipment.

No deficiencies were cited or observed on this date.

An exit interview was conducted with Laura Casas Griggs. A copy of this report was provided to Laura Casas Griggs whose signature below verifies receipt of these rights.

The report was originally hand written due to technical issues; see hard copy in file.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE: DATE: 05/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/04/2022
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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