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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604060
Report Date: 07/24/2020
Date Signed: 08/21/2020 12:39:09 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:GROSSMONT GARDENSFACILITY NUMBER:
374604060
ADMINISTRATOR:KAITLIN RUDOLPHFACILITY TYPE:
740
ADDRESS:5480 MARENGO AVETELEPHONE:
(619) 463-0281
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:425CENSUS: 240DATE:
07/24/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Business Office Coordinator, Natalie GramseTIME COMPLETED:
01:20 PM
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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced video call to conduct a case management visit due to COVID-19, to ensure confirmation of removal of S1 (see LIC 811 for confidential names). LPA Correia met with Business Office Coordinator, Natalie Gramse and explained the purpose of the visit.

Interview with staff and a record review revealed S1's last day on the premises was April 28, 2020 and S1 was officially terminated July 7th, 2020. S1 is excluded to prior administrative action. No deficiencies were cited during today's visit.

An exit interview was conducted with Business Office Coordinator, Natalie Gramse and a copy of this report, LIC 811 and Licensee Appeal Rights (LIC 9058) have been given for facility records.

SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2020
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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