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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603789
Report Date: 05/15/2023
Date Signed: 05/15/2023 01:18:07 PM

Document Has Been Signed on 05/15/2023 01:18 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:LA MESA WORK CENTER ANNEXFACILITY NUMBER:
374603789
ADMINISTRATOR:SACOCO, DEONNAFACILITY TYPE:
775
ADDRESS:3403 E PLAZA BLVD SUITE HTELEPHONE:
(619) 267-7796
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY: 40CENSUS: 39DATE:
05/15/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Deonna Sacoco, Program DirectorTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced collateral visit to the Day Program to conduct staff and client interviews. LPA Lopez identified herself and stated the purpose of the visit with Alex Arellano, Day Program Designee/Associate Director/Registered Nurse. Program Director Deonna Sacoco later arrived and joined the visit.

During the visit, LPA Lopez interviewed staff members and a client. No deficiencies were observed during today's visit.

An exit interview was conducted, and a copy of this report along with Licensee/Appeal Rights (LIC9058 03/22) was provided to Deonna Sacoco, Program Director, at the conclusion of the visit via email. The signature below and an email receipt confirms the receipt of the documents.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2023
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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