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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604135
Report Date: 05/06/2021
Date Signed: 05/06/2021 01:52:47 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:SHADOWRIDGEFACILITY NUMBER:
374604135
ADMINISTRATOR:KIRBY, SCOTTFACILITY TYPE:
740
ADDRESS:2354 WATSON WAYTELEPHONE:
(760) 295-3888
CITY:VISTASTATE: CAZIP CODE:
92081
CAPACITY:48CENSUS: 35DATE:
05/06/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Beatrice Bracamonte, AdministratorTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Carmen Lopez conducted a Case Management visit, to conduct an unannounced tele-visit due to COVID-19 Inquiry/Concern. The visit was conducted via tele-visit, using the FaceTime application, with Administrator, Beatrice Bracamonte. Tele-visits are conducted due to COVID-19 restrictions. LPA conducted the virtual call with Beatrice Bracamonte, Administrator, identified herself and disclosed the purpose of the virtual visit.

During today's visit, LPA spoke with Administrator Bracamonte and requested copies of relevant documents.

No deficiencies were cited during today’s call.

An exit interview was conducted with Beatrice Bracamonte, Administrator, via virtual visit, and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided to Beatrice Bracamonte, Administrator, via electronic mail. An electronic read receipt confirms the documents were received.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2021
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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