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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604232
Report Date: 08/06/2020
Date Signed: 08/06/2020 11:43:17 AM

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:REMINGTON CLUB IIFACILITY NUMBER:
374604232
ADMINISTRATOR:HUMORA, ALISONFACILITY TYPE:
740
ADDRESS:16922 HIERBA DRIVETELEPHONE:
(617) 796-8350
CITY:SAN DIEGOSTATE: CAZIP CODE:
92128
CAPACITY:140CENSUS: 80DATE:
08/06/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Administrator, Alison HumoraTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA), Natasha Persaud, contacted the facility via telephone to conduct a Case Management Visit- Other regarding a Criminal Record Exemption. The visit is being conducted via telephone due to COVID-19. LPA identified herself and explained the purpose of the call to Administrator, Alison Humora

During the call, visual conference with the Administrator, LPA explained Staff #1 (S1) requires a Criminal Record Exemption. On 07/30/20, Community Care Licensing received a Confirmation of Removal for S1. Executive Director, Kristen Kearnaghan signed the Confirmation of Removal stating they will not employ or allow S1 to reside in the facility. S1 worked in the food and beverage department. The facility is not pursuing an exemption request for S1. Administrator verified that S1 was not currently on site. S1's last day of employment was on 07/27/20. Administrator is aware S1 is not allowed on the premises and may not return prior to an approved exemption. No deficiencies were issued.

An exit interview was conducted via telephone, and a copy of this report and Licensee Rights (9058 01/16) were emailed to the Administrator. An email read receipt confirms the acceptance of these documents. [See LIC 811 Confidential Names List to identify Staff #1]
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2020
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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