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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604384
Report Date: 12/04/2023
Date Signed: 12/04/2023 04:06:12 PM

Document Has Been Signed on 12/04/2023 04:06 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:JOSEPHINE'S HOME 2FACILITY NUMBER:
374604384
ADMINISTRATOR:SO, JOSEFINA M.FACILITY TYPE:
735
ADDRESS:1452 MULLIGAN HILL STTELEPHONE:
(619) 948-7101
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY: 4CENSUS: 4DATE:
12/04/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Josephina M. So, LicenseeTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced collateral visit to the facility to conduct an interview. LPA Lopez identified herself and was granted entry by Josephina So, Licensee. LPA stated the purpose of the visit with Licensee So.

During the visit, LPA Lopez interviewed client #1 (C1) (See LIC811 Confidential Names list) and requested and obtained relevant documents. No deficiencies were observed during today's visit.

An exit interview was conducted, and a copy of this report along with Licensee/Appeal Rights (LIC9058 03/22) was provided to Josephina So, Licensee at the conclusion of the visit. The signature below confirms the receipt of the documents.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 12/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/04/2023
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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