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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604151
Report Date: 04/22/2021
Date Signed: 04/22/2021 01:26:56 PM

Document Has Been Signed on 04/22/2021 01:26 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:REINA'S CARING COTTAGEFACILITY NUMBER:
374604151
ADMINISTRATOR:FLECK, KEVINFACILITY TYPE:
740
ADDRESS:9290 MURRAY DRTELEPHONE:
(858) 842-1299
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY: 9CENSUS: 6DATE:
04/22/2021
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Kevin FleckTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Dang Nguyen conducted a case management visit to provide technical assistance regarding COVID-19. Due to the pandemic, the visit was conducted via video telephone call. LPA identified himself and stated the purpose of the visit to Administrator Kevin Fleck.

During today’s visit, LPA briefly toured the facility and provided consultation regarding the facility’s COVID-19 Mitigation Plan. No deficiencies were cited during the visit.

An exit interview was conducted with the administrator, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided via E-mail. A reply E-mail or read receipt confirmation was requested from the administrator upon receipt of documents.

SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 04/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/22/2021
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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