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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603907
Report Date: 09/14/2023
Date Signed: 09/14/2023 10:53:11 AM

Document Has Been Signed on 09/14/2023 10:53 AM - 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:SAM AND ROSE STEIN EDUCATION CENTERFACILITY NUMBER:
374603907
ADMINISTRATOR:JOANNE GARCIAFACILITY TYPE:
775
ADDRESS:6070 MISSION GORGE RDTELEPHONE:
(619) 281-5031
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY: 97CENSUS: 81DATE:
09/14/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Adrian Rodriguez, Program SupervisorTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Dawn Segura conducted an unannounced Collateral Visit. LPA introduced herself and was granted entry into the facility by Adrian Rodriguez, Program Supervisor, to whom she disclosed the purpose of the visit.

During today's visit, LPA attempted to interview day program participants; however, LPA was informed that the participants were out in the community. LPA obtained information relative to client locations.

No deficiencies were cited during the visit.

This report was discussed with Adrian Rodriguez, Program Supervisor. Copies of this report and Licensee/Appeal Rights were provided to the Program Supervisor at the conclusion of the visit. His signature on this form acknowledges receipt of copies of the rights and the report.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2023
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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