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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604275
Report Date: 08/28/2024
Date Signed: 08/28/2024 12:45:49 PM

Document Has Been Signed on 08/28/2024 12:45 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:REHOBOTH HOMESFACILITY NUMBER:
374604275
ADMINISTRATOR/
DIRECTOR:		GONZALEZ JR, EDUARDOFACILITY TYPE:
735
ADDRESS:936 REDBUD RDTELEPHONE:
(619) 349-3131
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 4CENSUS: 4DATE:
08/28/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:15 PM
MET WITH:Melinda PontanaresTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced Case Management Visit.  LPA was greeted by and met with Administrator Melinda Pontanares, to discuss the purpose of the visit. 

Today's visit is in response to the self reported incident of Client 1 (C1 - see LIC811 Confidential Names List) who cut their hand with scissors resulting in sutures.

LPA interviewed C1 and staff and obtained facility records. C1 was taken to the hospital on 8/23/24 and returned to the facility several hours later. No deficiencies were cited or observed on this date. 

An exit interview was conducted with Melinda Pontanares, who was provided with a copy of this report and Appeal Rights. Their signature confirms receipt of these documents.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE: DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/28/2024
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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