<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604298
Report Date: 11/16/2021
Date Signed: 11/16/2021 04:27:47 PM

Document Has Been Signed on 11/16/2021 04:27 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:MACKENZIE CARE HOMEFACILITY NUMBER:
374604298
ADMINISTRATOR:PREECE, RAQUELFACILITY TYPE:
735
ADDRESS:2487 MACKENZIE CREEK RTELEPHONE:
(760) 460-1129
CITY:CHULA VISTASTATE: CAZIP CODE:
91914
CAPACITY: 4CENSUS: 4DATE:
11/16/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:03 PM
MET WITH:Raquel PreeceTIME COMPLETED:
04:49 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Kennedy conducted a case management visit regarding an incident report that was received by CCL on 11-15-21 for Client 1 (C1). LPA identified herself and discussed the purpose of the visit with Raquel Preece, Licensee. The purpose of this visit was to follow up on the incident reports regarding the AWOL of C1. (See LIC 811 Confidential Names.)

Incident report dated 11-14-21 regarding C1 who was in the backyard engaged in a solitary activity. The staff member went to check on another client. When the staff member checked on C1 they were no longer in the backyard. The staff member looked for C1 and found them a few houses away from the home. C1 returned to the facility without incident. C1 was not injured during the incident.

No deficiencies cited today during visit.

An exit interview was conducted with Raquel Preece, Licensee A copy of this report was provided to the Ms. Preece via email. An electronic response confirms the documents were received. Licensee Rights (LIC9058 01/2016) were left at the facility.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Anna Kennedy
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1