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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603746
Report Date: 08/24/2022
Date Signed: 08/24/2022 01:41:38 PM


Document Has Been Signed on 08/24/2022 01:41 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
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:CHHINA'S SENIOR GUEST HOUSEFACILITY NUMBER:
374603746
ADMINISTRATOR:CHHINA, JIWAN SFACILITY TYPE:
740
ADDRESS:8632 SPRING VISTA WAYTELEPHONE:
(619) 337-5201
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:6CENSUS: 6DATE:
08/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Sukminder Chhina and Jiwan ChhinaTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Renita Hall, and Licensing Program Manager Denise Powell (LPM) conducted an unannounced Required 1 – Year Visit. The facility file was reviewed prior to the visit. LPA met with Sukminder "Sukhi" Chhina and Jiwan Chhina "Jay"and we discussed the purpose of the visit. All staff present have a current criminal record clearance.


LPA and LPM conducted a tour of the facility, both inside and outside. In accordance with the Department’s Infection Control, LPA and LPM 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. Additional was guidance regarding mask and exits doors not being blocked.

An exit interview was conducted. The Licensee was provided a copy of their appeal rights (LIC9058 01/16), along with a copy of this report.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 767-2330
LICENSING EVALUATOR NAME: Renita HallTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 08/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/24/2022
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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