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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604135
Report Date: 07/15/2021
Date Signed: 07/15/2021 04:34:49 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: 33DATE:
07/15/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Beatrice Bracamonte, AdministratorTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA), Carmen Lopez, and Licensing Program Manager (LPM), Denise Powell, conducted a Case Management visit, to follow-up on an incident report received on 7/12/21. LPA and LPM identified themselves and was granted entry by Rocio Rodriguez, Housekeeper. LPA and LPM met with Beatrice Bracamonte, Administrator, and disclosed the purpose of today’s visit.

During the visit, LPA Lopez and LPM Powell toured the facility, spoke to staff, and requested and obtained relevant documents. No deficiencies were cited.

An exit interview was conducted with Beatrice Bracamonte, Administrator, 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: 07/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2021
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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