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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603818
Report Date: 07/28/2023
Date Signed: 07/28/2023 01:56:50 PM

Document Has Been Signed on 07/28/2023 01:56 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: 5DATE:
07/28/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Assistant Manager Eloisa Marin-WatsonTIME COMPLETED:
02:05 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Assistant Manager Eloisa Marin-Watson. LPA also spoke with Program Manager Monica McDade via phone during the visit.

Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office (received on 07/25/2023). According to the LIC624: on the morning of 07/24/2023, Client #1 (C1) eloped from the facility (and left staff supervision). [See LIC 811 Confidential Names List for a description of C1.] C1 was located and returned to the facility unharmed later the same day.

During today’s visit, LPA performed a brief facility tour and welfare check, verifying that C1 and their peers were safe. LPA also reviewed pertinent care records and interviewed relevant staff.

Based on information obtained from records and interviews: staff provided needed observation to C1 leading up to their elopement, staff followed the facility's absentee notification plan following the elopement, and licensee met reporting requirements. No deficiencies were cited for this incident.

Also, no deficiencies were observed or cited during today's visit.

An exit interview was conducted with Marin-Watson. A copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided to McDade during the visit.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2023
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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