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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604126
Report Date: 09/29/2020
Date Signed: 09/29/2020 01:52:33 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:JAMES BOARD AND CAREFACILITY NUMBER:
374604126
ADMINISTRATOR:ARAGON, SARAH CHRISTINEFACILITY TYPE:
740
ADDRESS:6045 REO PLTELEPHONE:
(619) 434-9850
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY:6CENSUS: 2DATE:
09/29/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Sarah Aragon, AdministratorTIME COMPLETED:
01:25 PM
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Regional Manager (RM), Icela Estrada and Licensing Program Manager (LPM), Denise Powell conducted an on-site case management visit to check on the welfare of the residents in care. RM and LPM identified themselves and discussed the purpose of the visit with Administrator, Sarah Aragon.

The RM and LPM went over the on-site assessment conducted on August 4, 2020, by CDPH HAI, County of San Diego Public Health, and Regional Manager, Icela Estrada. During the walk-through, the RM interviewed caregiver, Romano Aragon and interviewed Resident #1 (R1) and briefly interacted with Resident #2. The RM provided consultation to the Administrator and caregiver on change of condition, observation of resident, reporting requirements, and sanitation of the facility. RM obtained copies of R1's records.

During today's visit, no deficiencies were issued. An exit interview was conducted with Ms. Aragon and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to the Administrator via electronic mail. An electronic receipt of confirmation was requested to be sent by the Administrator upon receipt of the documents.
SUPERVISOR'S NAME: Ley ArquisolaTELEPHONE: (916) 657-2592
LICENSING EVALUATOR NAME: Icela EstradaTELEPHONE: (619) 688-6866
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2020
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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