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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604330
Report Date: 02/24/2023
Date Signed: 02/24/2023 02:59:27 PM

Document Has Been Signed on 02/24/2023 02:59 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
SO. CAL AC/SC, 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: 28DATE:
02/24/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Assistant Manager Joseph BakerTIME COMPLETED:
03:10 PM
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Licensing Program Analyst (LPA) Tammer De Los Santos conducted an unannounced case management visit. LPA was granted entry into the facility by Assistant Manager Joseph Baker, to whom LPA disclosed the purpose of the visit.

It was reported to Community Care Licensing that, on February 10, 2023, at approximately 01:00 PM, C1 eloped. Around 20 minutes later, C1 was located by staff. No injuries were reported.

During today’s visit, LPA briefly toured the facility, obtained pertinent records, and interviewed staff.

No deficiencies were cited during today’s visit. An exit interview was conducted with Assistant Manager Joseph Baker. Copies of this report, Confidential Names List (LIC 811), and Licensee Rights (LIC 9058) were provided at the conclusion of the visit. Facility representative’s signature on this form acknowledges receipt of the rights and a copy of the report.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tammer DeLosSantos
LICENSING EVALUATOR SIGNATURE: DATE: 02/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/24/2023
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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