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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604282
Report Date: 05/21/2024
Date Signed: 05/21/2024 09:38:00 PM

Document Has Been Signed on 05/21/2024 09:38 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:ABIGAIL'S HOMES IIIFACILITY NUMBER:
374604282
ADMINISTRATOR/
DIRECTOR:		GONZALEZ, BRENDA ABIGAILFACILITY TYPE:
735
ADDRESS:2505 ARCADIA AVETELEPHONE:
(619) 439-7791
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY: 4CENSUS: 1DATE:
05/21/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Care Giver Katie JenningsTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
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Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Case Management visit to follow-up on an incident reported to Community Care Licensing. LPA met with Care giver Katie Jennings to discussed the purpose of the visit. LPA Rodgers also discussed the visit with Raquel Garcia over the phone.

Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office (received on 05/14/2024). According to the LIC624 and interview: on the evening of 05/13/2024 Client #1 (C1) went AWOL (absent without leave) from their outing and as of 5/21/2024 has not returned.[See LIC 811 Confidential Names List for a description of C1.] Facility staff began looking throughout the outing facility and then informed local security to help locate C1. After security reviewed camera it was discovered C1 left the property. Police were contacted and a missing person report was filed by Administrator Raquel Garcia.

According to C1’s latest LIC602 Physician’s Report (dated 9/6/2022) their doctor determined that C1 was able to safely leave the facility unassisted. During today's visit, LPA conducted a health and safety check of the client in care. No deficiencies were cited during today’s visit.


An exit interview was conducted with care giver Katie Jennings and was provided a copy of their appeal rights (LIC9058 03/22), LIC811, this report and their signature on this form, acknowledges receipt of these rights.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2024
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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