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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604132
Report Date: 03/01/2022
Date Signed: 03/01/2022 11:00:29 PM


Document Has Been Signed on 03/01/2022 11:00 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:RUSSELL HOMES INC SANTEEFACILITY NUMBER:
374604132
ADMINISTRATOR:MCKNIGHT COLE, TRACYFACILITY TYPE:
735
ADDRESS:10214 THREE OAKS WAYTELEPHONE:
(619) 592-1424
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY:4CENSUS: 4DATE:
03/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
04:40 PM
MET WITH:House Manager Bandy Brennan and Administrator Krista DuvallTIME COMPLETED:
06:15 PM
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Licensing Program Analyst (LPA) Debbie Correia visited the facility to conduct an annual required licensing inspection. LPA Correia was met by House Manager Bandy Brennan and Administrator Krista Duvall, identified herself, and was granted entry into the facility.

During today's visit, LPA, accompanied by House Manager Brennan and Administrator Duvall, toured the facility, and verified compliance with infection control practices. LPA and Administrator Duvall reviewed the facility’s Plan for Epidemic Outbreak Specific to COVID-19 Mitigation Plan. LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff, clients and visitors; a sign-in policy enacted for all visitors; signs posted throughout the facility to promote hand hygiene, cough/sneeze etiquette and physical distancing; face coverings worn by staff; hand sanitizer/hand washing stations readily available; emergency agencies’ contact information posted in a location visible to staff and clients; and an adequate supply of cleaning products and PPE.

No deficiencies were cited during today’s visit. An exit interview was conducted with Administrator Duvall and a copy of this report, along with the Licensee Rights (LIC 9058 FAS 01/16) were provided to the Administrator and House Manager via email. An electronic receipt of confirmation was requested to be sent by Administrator Duvall upon receipt of the documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:
DATE: 03/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/01/2022
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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