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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604330
Report Date: 08/31/2022
Date Signed: 08/31/2022 03:08:50 PM

Document Has Been Signed on 08/31/2022 03:08 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:AMARIS CENTER FOR CHANGEFACILITY NUMBER:
374604330
ADMINISTRATOR:GASQUE, RUKHSANAFACILITY TYPE:
775
ADDRESS:250 E DOUGLAS AVETELEPHONE:
(202) 520-3781
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY: 40CENSUS: 27DATE:
08/31/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Rukhsana Gasque, LicenseeTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Vicky Williamson conducted an unannounced case management visit to follow up on an incident report, received by Community Care Licensing on 8/24/22. LPA was granted entry into the facility by Joseph Baker, Assistant Program Director. LPA then met with Rukhsana Gasque, Licensee, with whom she discussed the purpose of the visit.

The incident reported the absence without leave (AWOL) of Client 1 (C1) (See LIC 811 Confidential Names to identify C1) that occurred on 8/22/22. C1 was last seen at the facility on 8/22/22 at 1:00pm. Per Joseph Baker, Assistant Program Director, C1 became upset when they ran out of their cigarettes. C1 told Assistant Program Director that they contacted their mother and she stated that they could come by the home and visit. Assistant Program Director advised C1 that they would need to obtain permission from Jose Gonzales, who is the Administrator at the home in which C1 resides. C1 left the facility and walked to their mother’s home. Licensee Rukhsana Gasque, stated that the facility was notified by the El Cajon Police Department that C1 was picked up from their mother's home by Administrator Jose Gonzales.

Records reviewed determined that C1 is not allowed off the premises without supervision. Staff followed the Absentee Notification Plan and contacted C1’s responsible party, however was unable to reach him. The El Cajon Police Department were contacted and a missing person’s report was filed.

During today's visit, LPA Williamson conducted an interview with Joseph Baker, Assistant Program Director and Rukhsana Gasque, Licensee and reviewed the records for C1.

No deficiencies were issued during today's visit. An exit interview was conducted with Rukhsana Gasque, Licensee, to whom a copy of this report and the Licensee's/Appeal Rights (LIC9058 01/16) were provided.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Vicky Williamson
LICENSING EVALUATOR SIGNATURE: DATE: 08/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/31/2022
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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