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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604051
Report Date: 03/03/2022
Date Signed: 03/04/2022 04:45:06 PM


Document Has Been Signed on 03/04/2022 04:45 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:ATRIA RANCHO PENASQUITOSFACILITY NUMBER:
374604051
ADMINISTRATOR:HERNANDEZ, MARIANO QUINNFACILITY TYPE:
740
ADDRESS:12979 RANCHO PENSAQUITOS BLVDTELEPHONE:
(858) 201-6458
CITY:SAN DIEGOSTATE: CAZIP CODE:
92129
CAPACITY:120CENSUS: 78DATE:
03/03/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Executive Director, Carline CallaghanTIME COMPLETED:
04:25 PM
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On 3/3/2022, at 2:10 p.m., Licensing Program Analyst (LPA), Sabel Martinez conducted an unannounced case management visit to the facility in response to a self reported incident. LPA was greeted by Executive Director, Carline Callaghan, introduced himself, and discussed the purpose of the visit

On 3/3/2022, the Regional Office received an Unusual Incident Report (LIC 624) of a resident who left the facility, was later located by staff, and was redirected back to the facility. During today's visit, the LPA conducted a tour of the facility, conducted interviews with staff, collected, and reviewed the resident's records. No deficiencies were cited during today's visit, and future visits may be necessary.

An exit interview was conducted with Executive Director, Carline Callaghan, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058 01/16) were provided via E-mail. An email read receipt confirms these documents were received by Executive Director, Carline Callaghan.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 03/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/03/2022
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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