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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604062
Report Date: 09/11/2020
Date Signed: 09/11/2020 11:54:22 AM

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:ELMCROFT OF POINT LOMAFACILITY NUMBER:
374604062
ADMINISTRATOR:SHEARER, KELLIEFACILITY TYPE:
740
ADDRESS:3423 CHANNEL WAYTELEPHONE:
(619) 224-7300
CITY:SAN DIEGOSTATE: CAZIP CODE:
92110
CAPACITY:60CENSUS: 37DATE:
09/11/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:53 AM
MET WITH:Business Office Coordinator, Grace RuizTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted a Case Management tele-visit. This visit was conducted via FaceTime due to COVID-19. LPA identified herself and discussed the purpose of the visit with Business Office Coordinator, Grace Ruiz.

The purpose of the visit was to discuss Incident Reports received in our office on 08/10/2020, 08/17/2020 and 08/21/2020. During today’s visit, LPA interviewed staff, requested copies of client records and toured the facility. No deficiencies were observed during today’s visit.

An exit interview was conducted with the Business Office Coordinator, Grace Ruiz and a copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Grace Ruiz via email with an electronic read receipt.
SUPERVISOR'S NAME: Tony GirolamiTELEPHONE: (619) 767-2312
LICENSING EVALUATOR NAME: Elizabeth HamiltonTELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2020
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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