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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603778
Report Date: 07/21/2022
Date Signed: 07/21/2022 03:28:39 PM


Document Has Been Signed on 07/21/2022 03:28 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:HERITAGE HILLSFACILITY NUMBER:
374603778
ADMINISTRATOR:LEMASTER, SUZY PFACILITY TYPE:
740
ADDRESS:2108 EL CAMINO REALTELEPHONE:
(760) 206-7930
CITY:OCEANSIDESTATE: CAZIP CODE:
92054
CAPACITY:74CENSUS: 63DATE:
07/21/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:07 PM
MET WITH:Stefanie Ancheta, Executive Director TIME COMPLETED:
03:30 PM
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Licensing Program Analyst, Daniela Huerta and Interim Assistant Program Administrator (IAPA) Icela Estrada conducted an unannounced case management visit to follow up on an Incident Report received by the Regional Office on 07/08/2022. LPA and IAPA identified themselves, stated the purpose of the visit, and met with Stefanie Acheta, Executive Director.

During the visit, LPA and IAPA toured the facility, observed residents in care, reviewed and obtained copies of facility records. No immediate health and safety concerns were observed during the visit.

No deficiencies were observed or cited on this date. An exit interview was conducted with Executive Director Stefanie Acheta, to whom a copy of this report and the Licensee Rights (LIC 9058 01/16) were provided.

SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniela HuertaTELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2022
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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