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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604298
Report Date: 01/17/2024
Date Signed: 01/17/2024 05:14:02 PM

Document Has Been Signed on 01/17/2024 05:14 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:MACKENZIE CARE HOMEFACILITY NUMBER:
374604298
ADMINISTRATOR:PREECE, RAQUELFACILITY TYPE:
735
ADDRESS:2487 MACKENZIE CREEK RTELEPHONE:
(619) 752-9851
CITY:CHULA VISTASTATE: CAZIP CODE:
91914
CAPACITY: 4CENSUS: 4DATE:
01/17/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Administrator Raquel PreeceTIME COMPLETED:
05:30 PM
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Licensing Program Analysts (LPAs) Amy Rodgers and Dang Nguyen conducted an unannounced Case Management - Incident visit. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit with Administrator Raquel Preece.

Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office (received on 01/16/2024), involving Client #1 (C1) being sent to the hospital for a broken ankle. [See LIC 811 Confidential Names List for a description of C1.]

During today’s visit, LPA performed a facility tour, collected pertinent records, and interviewed relevant staff. As of the date of LPA’s site visit, C1 was still a the hospital.

No deficiencies were cited during today’s visit.

An exit interview was conducted with Preece, to whom a copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2024
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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