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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604148
Report Date: 02/15/2024
Date Signed: 02/15/2024 12:43:06 PM

Document Has Been Signed on 02/15/2024 12:43 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:ABIGAIL'S HOMES IIFACILITY NUMBER:
374604148
ADMINISTRATOR:GONZALEZ, BRENDA ABIGAILFACILITY TYPE:
735
ADDRESS:8738 VALENCIA STTELEPHONE:
(619) 315-7407
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY: 4CENSUS: DATE:
02/15/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:House Manager Raquel GarciaTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management – Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with House Manager Raquel Garcia.

Today's visit was in response to two (2) Special Incident Reports (SIRs), which Licensee self-submitted to the CCLD San Diego Regional Office (received on 02/14/2023 and 02/15/2023, respectively). The first SIR described a medication incident involving Client #1 (C1). The second SIR described a medication incident involving Client #2 (C2). [See LIC 811 Confidential Names List for a description of person identifiers used in this report].

During today’s visit, C1 and C2 were both off-site at day program. LPA performed a brief facility tour, interviewed relevant staff, and collected copies of pertinent care and medication records for C1 and C2.

Manager interview showed: The above incidents did not result in any adverse health consequence to either C1 or C2.

No deficiencies were cited during today’s site visit.

An exit interview was conducted with Garcia, to whom a copy of this report, he LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2024
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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