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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603818
Report Date: 09/21/2022
Date Signed: 09/21/2022 03:32:39 PM

Document Has Been Signed on 09/21/2022 03:32 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:EUBANK CASTLEFACILITY NUMBER:
374603818
ADMINISTRATOR:ANETA STANEK DE LAFACILITY TYPE:
735
ADDRESS:1528 SANGAMON AVENUETELEPHONE:
(619) 825-6473
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY: 6CENSUS: 4DATE:
09/21/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Monica McDade, Program DirectorTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced case management visit. LPA met with Monica Mc Dade, Program Director and we discussed the purpose of the visit.

LPA conducted a tour of the facility. Community Care Licensing received an incident report on 09/19/2022. Incident report states that Client#1 (C1) AWOL'd on 09/15/2022 and did not return on the same day. C1 returned on 09/16/2022 in the am. Staff observed C1 on the main road down the street from the facility. No injuries noted and no other incidents noted. The facility followed their Absentee notification plan and contacted the sheriffs department to report C1 missing. The facility staff is working with C1 and a behavior specialist and the San DIego Regional Center in regards to C1 AWOLing frequently.

Based on today's visit, no deficiencies were cited at this time. An exit interview was conducted with McDade and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) was provided to McDade at the end of the visit
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2022
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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