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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604245
Report Date: 09/15/2022
Date Signed: 09/15/2022 03:09:50 PM

Document Has Been Signed on 09/15/2022 03:09 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:CHLOE'S HOMEFACILITY NUMBER:
374604245
ADMINISTRATOR:ENGAY, ERWINFACILITY TYPE:
735
ADDRESS:228 CARTER STREETTELEPHONE:
(619) 995-8874
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY: 4CENSUS: 4DATE:
09/15/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:01 PM
MET WITH:Licensee, Erwin Engay TIME COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an unannounced case management visit at the facility. LPA was greeted at the front entrance by Licensee, Erwin Engay and granted entry after identifying herself. LPA explained the purpose of the visit with Licensee, Engay which was to discuss regulations regarding three day and thirty-day eviction notices and additional guidance on reporting requirements, personal rights and client records.

During this visit, LPA advised Licensee of Title 22, Division 6, Chapter 1, Article 6 Continuing Requirements, Section 80068.5 Eviction Notices and Section 80068.3. Modifications to Needs and Services Plan. LPA advised the Licensee how to submit a 30-day Eviction Notice to Community Care Licensing (CCL) for review. LPA further advised Licensee on reporting requirements, client records and personal rights. Technical Advisory given.

No deficiencies were cited during this visit. An exit interview was conducted with Licensee, Engay and a copy of this report and Licensee/Appeals Rights (LIC 9058 01/16) was provided.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Elizabeth Hamilton
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2022
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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