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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604339
Report Date: 05/23/2022
Date Signed: 05/23/2022 03:58:12 PM

Document Has Been Signed on 05/23/2022 03:58 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:SIENA HOME CARE LLCFACILITY NUMBER:
374604339
ADMINISTRATOR:MASCARDO, ERLINDAFACILITY TYPE:
735
ADDRESS:282 S SIENA ST.TELEPHONE:
(619) 470-0908
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY: 4CENSUS: 2DATE:
05/23/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Erlinda MascardoTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced case management visit to investigate a client death. LPA identified herself to, was allowed entry by, and explained the purpose of the visit to Caregiver Johnpiolo Mercado. Administrator Erlinda Mascardo arrived during the visit.

An Incident Report was received by the Department on 5/20/2022 informing of the death of Client 1 (C1) [Administrator was provided with an LIC811 Confidential Names List to identify C1] that occurred on 5/18/2022. During today's visit, LPA toured the facility, reviewed and obtained copies of facility records, and interviewed staff.

No deficiencies were cited during today's visit. An exit interview was conducted with Administrator Erlinda Mascardo, to whom a copy of this report and the Licensee Rights (LIC9058 01/16) were provided via hard copy.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 05/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/23/2022
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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