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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603870
Report Date: 06/22/2022
Date Signed: 06/22/2022 03:05:05 PM


Document Has Been Signed on 06/22/2022 03:05 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 CRUZ SENIOR CARE, INCFACILITY NUMBER:
374603870
ADMINISTRATOR:CRUZ, LINDAFACILITY TYPE:
740
ADDRESS:1882 EUCLID AVENUETELEPHONE:
(619) 401-5314
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY:6CENSUS: 6DATE:
06/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Linda Cruz, AdministratorTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Amy Domingo made an unannounced visit to the facility to conduct an annual required licensing inspection. LPA identified herself, and met with Linda Cruz, Administrator and discussed the purpose of today’s visit.

A tour of the facility was conducted inside and out. LPA, accompanied by facility staff conducted a general overall inspection, with specific focus on infection control.

During today's inspection LPA observations include the following: Symptom screening procedures for staff, residents and visitors; posted signs including visitor policy, promoting hand washing, cough and sneeze etiquette and other infection control procedures; Hand hygiene practices; testing plan and procedures; plans for containing infections, PPE supplies procedures and training; and disinfection procedures.

Based on today’s inspection, no deficiencies were observed at this time in the areas evaluated. This report was discussed with Linda Cruz, Administrator. The Licensee was provided a copy of their appeal rights (Lic 9058 01/16), along with a copy of this report.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 767-2330
LICENSING EVALUATOR NAME: Amy DomingoTELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2022
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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