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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603734
Report Date: 02/17/2023
Date Signed: 02/17/2023 10:29:32 AM

Document Has Been Signed on 02/17/2023 10:29 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
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: 26DATE:
02/17/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
09:34 AM
MET WITH:Laura Casas-GriggsTIME COMPLETED:
10:39 AM
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Licensing Program Analyst (LPA), Ramon Serrano, conducted an unannounced collateral visit as a follow-up for an unrelated complaint investigation for another facility. LPA was allowed entry by Administrator Laura Casas-Griggs and discussed the purpose of the visit.

During the visit, LPA interviewed several clients in care.

An exit interview was conducted with Laura Casas-Griggs and a copy of this report along with Licensee Rights (LIC 9058 3/22) was provided to Laura Casas-Griggs whose signature below verifies receipt of these rights.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE: DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2023
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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