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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604034
Report Date: 02/10/2021
Date Signed: 02/10/2021 03:52:10 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:JULIE'S ELDERLY CAREFACILITY NUMBER:
374604034
ADMINISTRATOR:NYNAS, JULIEFACILITY TYPE:
740
ADDRESS:9041 INVERNESS ROADTELEPHONE:
(619) 992-8427
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY:6CENSUS: 4DATE:
02/10/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrator Julie NynasTIME COMPLETED:
02:40 PM
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Licensing Program Manager John Rante, County of San Diego Nurses Jeffrey Meilander and Sandra Brackman, and California Department of Public Health, Health Facility Evaluator Nurse Michelle Hose, conducted an announced on-site visit. LPM and team identified themselves and discussed the purpose of the visit with Administrator Julie Nynas.

The Department conducted an on-site visit to provide technical assistance and to evaluate the facility's mitigation plan to include disinfection, testing surveillance, and screening protocols as well as the use of personal protective equipment (PPE). During today's visit, the team interviewed Nynas and the team conducted a walk-though of the facility. A debriefing was conducted with Nynas at the conclusion of the visit.

During today's visit, no deficiencies were issued. An exit interview was conducted with the Nynas and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to Nynas via electronic mail. An electronic receipt of confirmation was requested to be sent by Nynas upon receipt of the documents.
SUPERVISOR'S NAME: Icela EstradaTELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2021
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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