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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604227
Report Date: 09/28/2020
Date Signed: 09/28/2020 05:12:19 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:SOMERFORD PLACE-ENCINITASFACILITY NUMBER:
374604227
ADMINISTRATOR:Y'LONN, HUDSONFACILITY TYPE:
740
ADDRESS:1350 S. EL CAMINO REALTELEPHONE:
(617) 796-8350
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:56CENSUS: 39DATE:
09/28/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:08 PM
MET WITH:Executive Director, Y'Lonn HudsonTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Debbie Correia conducted a Case Management visit via FaceTime due to COVID-19. LPA Correia identified herself and discussed the purpose of the call.

Today's visit was in response to a Unusual Incident Report regarding a resident (R1) who AWOL'd from the facility on September 20, 2020. (See LIC811 Confidential Names to identify R1). During today's visit, LPA interviewed staff and requested resident records maintained by the facility and obtained additional information about the AWOL. LPA Correia also conducted a facility tour. No deficiencies were cited during today's visit.

An exit interview was conducted and a copy of this report was emailed to the Executive Director along with a copy of their Licensee/Appeal Rights (LIC9058 1/16). An electronic read receipt email confirms the documents were received.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2020
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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