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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604232
Report Date: 02/23/2021
Date Signed: 02/23/2021 03:19:01 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:REMINGTON CLUB IIFACILITY NUMBER:
374604232
ADMINISTRATOR:HUMORA, ALISONFACILITY TYPE:
740
ADDRESS:16922 HIERBA DRIVETELEPHONE:
(858) 673-6333
CITY:SAN DIEGOSTATE: CAZIP CODE:
92128
CAPACITY:140CENSUS: 73DATE:
02/23/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Administrator, Alison HumoraTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA), Natasha Persaud contacted the facility via telephone regarding a Criminal Record Exemption. This inspection is being conducted, via FaceTime due to COVID-19. LPA introduced herself and explained the purpose of the call to Administrator, Alison Humora.

During the virtual inspection, LPA interviewed staff. LPA explained that Staff #1(S1) requires a Criminal Record Exemption. Administrator verified that S1 was not on-site. S1 was removed from the facility as of 01/15/21, and has not returned. Administrator is aware an approved exemption must be obtained prior to allowing S1 work. No deficiencies were issued during this visit.

An exit interview was conducted with Administrator, Alison Humora via FaceTime, and a copy of this report, along with Licensee/Appeal Rights (LIC9058 01/16) and List of Confidential Names were provided to the Administrator via electronic mail. An electronic read receipt confirmation was requested to be sent by the Administrator upon receipt of the 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: 02/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2021
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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