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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604156
Report Date: 03/02/2023
Date Signed: 03/02/2023 03:02:46 PM

Document Has Been Signed on 03/02/2023 03:02 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:RW RESIDENTIAL CARE LLCFACILITY NUMBER:
374604156
ADMINISTRATOR:CHUA, ROMEO BFACILITY TYPE:
735
ADDRESS:7654 PRAIRIE MOUND WAYTELEPHONE:
(619) 765-2807
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY: 4CENSUS: 4DATE:
03/02/2023
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Licensee Romeo "Romy" ChuaTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Dang Nguyen conducted an announced Case Management visit, accompanied by nurse contractors Robert Montanillo and Elizar Perez from the Healthcare Associated Infection (HAI) team of the San Diego County Health and Human Services Agency. LPA and HAI nurss were welcomed by, identified themselves to, and discussed the purpose of the visit with Licensee Romeo "Romy" Chua.

The Department conducted the on-site visit to briefly tour the facility, observe staff and clients, provide COVID-19 technical assistance, and deliver Personal Protective Equipment (PPE) supplies. No deficiencies were cited during this HAI Case Management visit.

An exit interview was conducted with Chua, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided via E-mail.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/02/2023
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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