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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604203
Report Date: 09/20/2022
Date Signed: 09/20/2022 03:19:35 PM

Document Has Been Signed on 09/20/2022 03:19 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:BEST STRAWBERRY RCFFACILITY NUMBER:
374604203
ADMINISTRATOR:HILTON, JAZMINFACILITY TYPE:
735
ADDRESS:10332 STRAWBERRY LANETELEPHONE:
(619) 501-7785
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY: 4CENSUS: 4DATE:
09/20/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Celina Brown, AdministratorTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced case management visit to the facility. LPA Lopez identified herself and was granted entry by Sandra Campbell, caregiver. LPA stated the purpose of the visit and reviewed the basic elements of the visit with caregiver Campbell. Celina Brown, Administrator later arrived and joined the visit

The facility self - reported an incident regarding Client #1 (C1) (See LIC 811 Confidential Names List) to Community Care Licensing on September 19, 2022. The facility reported that on September 19, 2022, C1 eloped from the facility but returned to the facility the same day with no injuries noted.

During today’s visit, LPA conducted interviews with staff and outside source, and requested and obtained client records. This case management does require further follow-up. No deficiencies were cited during this visit.

An exit interview was conducted with Administrator Celina Brown and a copy of this report, LIC 811 and Licensee/Appeal Rights (LIC 9058 03/22) were provided to the Licensee at the conclusion of the visit. The signature below confirms the documents were received.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2022
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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