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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604135
Report Date: 05/14/2021
Date Signed: 05/14/2021 04:48:31 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:
05/14/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:24 PM
MET WITH:Beatrice Bracamonte, Executive DirectorTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA), Carmen Lopez conducted an announced Case Management Visit. Virtual visits are conducted due to COVID-19 restrictions. LPA spoke with Beatrice Bracamonte, Executive Director, via FaceTime application. LPA identified herself to Executive Director Bracamonte and explained the purpose of the call.

The virtual visit was in response to the facility’s Mitigation Plan. LPA reviewed the elements of the plan with Executive Director Bracamonte and conducted a virtual tour. LPA observed proper mitigation protocols were in place and staff was observed wearing their face coverings.

No deficiencies were noted during today’s visit.

An exit interview was conducted via telephone and a copy of the report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Beatrice Bracamonte, Executive Director, via email. An electronic email 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: 05/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2021
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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