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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604330
Report Date: 02/03/2025
Date Signed: 02/04/2025 08:31:25 AM

Document Has Been Signed on 02/04/2025 08:31 AM - 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:AMARIS CENTER FOR CHANGEFACILITY NUMBER:
374604330
ADMINISTRATOR/
DIRECTOR:		GASQUE, RUKHSANAFACILITY TYPE:
775
ADDRESS:250 E DOUGLAS AVETELEPHONE:
(202) 520-3781
CITY:EL CAJONSTATE: CAZIP CODE:
92020
CAPACITY: 40CENSUS: 32DATE:
02/03/2025
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:40 AM
MET WITH:Administrator Shanta HainesTIME VISIT/
INSPECTION COMPLETED:
09:40 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Amy Rodgers and Arian Golbakhsh conducted an unannounced collateral visit as a follow-up for an unrelated complaint investigation for another facility. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit to Administrator Shanta Haines.

During the visit, LPAs conducted interviews with a few clients.

An exit interview was conducted with Administrator Haines to whom a copy of this report was provided. Their signature below confirms receipt of this document.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Arian Golbakhsh
LICENSING EVALUATOR SIGNATURE: DATE: 02/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/03/2025
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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