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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603746
Report Date: 03/01/2024
Date Signed: 03/04/2024 04:28:19 PM


Document Has Been Signed on 03/04/2024 04:28 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: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: 5DATE:
03/01/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
04:40 PM
MET WITH:LIcensee Jiway (Jay) ChhinaTIME COMPLETED:
05:15 PM
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An informal meeting was held via zoom with the San Diego Adult and Senior Care Regional Office. The following are the attendees of the virtual meeting: Associate Program Administrator (APA) Icela Estrada, Licensing Program Manager (LPM) Jennifer Lott, Licensing Program Analyst (LPA) Debbie Correia, and the Licensee. The purpose of this meeting was to develop Plans of Corrections (POCs) to address deficiencies that were deemed substantiated through a complaint investigation that was conducted by the Department.

APA Estrada explained a POC is a collaborative effort between the Licensee and the LPA that needs to be developed by law, even if there is a disagreement regarding the investigation findings. During the meeting, the Licensee agreed that they and their staff will attend Community Care Licensing approved trainings that address the specifics of each regulation. APA Estrada also informed the Licensee that the report will notate the Licensee’s willingness to implement the POCs even though they disagree with the findings, per their request.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2024
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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