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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604336
Report Date: 09/21/2022
Date Signed: 09/21/2022 11:37:42 AM


Document Has Been Signed on 09/21/2022 11:37 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:COMPASSIONATE CARE FOR SENIORS 1FACILITY NUMBER:
374604336
ADMINISTRATOR:BACINSKI, MAJAFACILITY TYPE:
740
ADDRESS:8100 BINNEY PL.TELEPHONE:
(619) 303-0670
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:6CENSUS: 6DATE:
09/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Maja Bacinski, LicenseeTIME COMPLETED:
12:20 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) Amy Domingo conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and discussed the purpose of the visit with Maja Bacinski Licensee. All staff that LPA encountered have a current criminal record clearance.

LPA conducted a brief tour of the facility and interacted with staff and residents. In accordance with the Department’s Infection Control, LPA provided technical assistance and observed and evaluated the facility's implementation of their COVID-19 Mitigation Plan and Infection Control Plan to include disinfection, screening protocols, and the use of personal protective equipment.

No deficiencies were cited or observed on this date.

An exit interview was conducted, and a copy of this report and Licensee Rights LIC 9058 (3/22) were left with the Licensee, whose signature on this form confirms receipt of these documents.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 767-2330
LICENSING EVALUATOR NAME: Amy DomingoTELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
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