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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603913
Report Date: 09/02/2020
Date Signed: 09/02/2020 01:15:56 PM

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:NOBLE LIVING II LLCFACILITY NUMBER:
374603913
ADMINISTRATOR:LEON, REBECCAFACILITY TYPE:
740
ADDRESS:505 HILLS LANE DRTELEPHONE:
(619) 938-4984
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY:6CENSUS: 4DATE:
09/02/2020
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Debra Bunnell, LicenseeTIME COMPLETED:
12:10 PM
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Licensing Program Manager, Denise Powell; County of San Diego Nurse Contractors, Elizar Perez and Jan West; California Department Public Health (CDPH), Health Facility Evaluator Nurses (HFEN), Maggie Turner and Michelle Hose with the HAI Program, conducted an on-site visit. LPM and team identified themselves and discussed the purpose of the visit with Licensee Debra Bunnell and Caregiver Mora Garcia.

The Department conducted the on-site visit to provide additional technical assistance and to re-evaluate the facility's disinfection and screening protocols as well as the use of personal protective equipment. During today's visit, the team interviewed the Licensee and Caregiver and provided consultation. The team conducted a walk-though of the facility and a debriefing was conducted with Ms. Bunnell at the conclusion of the visit.


During today's visit, no deficiencies were issued. An exit interview was conducted with Ms. Bunnell and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to the Licensee via electronic mail. An electronic receipt of confirmation was requested to be sent by the Licensee upon receipt of this report.
SUPERVISOR'S NAME: Icela EstradaTELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Denise PowellTELEPHONE: 619-301-9770
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2020
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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