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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604427
Report Date: 02/19/2025
Date Signed: 02/19/2025 10:23:31 AM

Document Has Been Signed on 02/19/2025 10:23 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:SACRED HEART HOME CARE 2FACILITY NUMBER:
374604427
ADMINISTRATOR/
DIRECTOR:		IMSON, EMMAFACILITY TYPE:
735
ADDRESS:823 CAMELLIA STTELEPHONE:
(858) 722-5094
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY: 4CENSUS: 3DATE:
02/19/2025
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:05 AM
MET WITH:Monica Schoberg, Caregiver TIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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On 02/19/25 at 9:05am, Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct a case management incident/health checks visit to follow up on Client #1 (C1's) death and to conduct a health and safety check. LPA was greeted and granted entry by Caregiver Monica Schoberg, where LPA explained the purpose of the visit. LPA spoke with Administrator Emma Imson via telephone. At the time of the visit there was (2) staff and (1) client present, (2) clients were at the day program.

During LPA's visit, LPA reviewed and obtained copies of pertinent documentation and conducted staff interviews to obtain further information leading up to and regarding the death of C1 who passed away on 02/17/25. The preliminary cause of death is unknown at this time. LPA advised Administrator Emma Imson to send a copy of the death certificate to the department as soon as it is becomes available.

No deficiencies were cited during this visit, as there were no health and safety concerns observed during today's visit.

An exit interview was conducted and a copy of this report (LIC 809) and LIC 811 (confidential names list, were provided to Monica Schoberg, Caregiver.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE: DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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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