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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604456
Report Date: 10/18/2023
Date Signed: 10/18/2023 07:17:14 PM


Document Has Been Signed on 10/18/2023 07:17 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:SAY YOU'RE HOMEFACILITY NUMBER:
374604456
ADMINISTRATOR:SAYRE, LISA HENDERLINGFACILITY TYPE:
740
ADDRESS:5971 LAKE MURRAY BLVD.TELEPHONE:
(619) 466-6993
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:6CENSUS: 6DATE:
10/18/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
06:05 PM
MET WITH:Caregiver Emma Ruth CuetoTIME COMPLETED:
07:30 PM
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management Visit to observe the physical plant. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Emma Ruth Cueto. LPA also met with Administrator Lisa Sayre, who arrived later during the visit.

The Licensee previously submitted a written request to the CCLD San Diego Regional Office (RO) seeking to increase the facility's bedridden resident capacity from zero (0) residents to one (1) resident. The request did not involve changing the facility's total capacity, which remains the same at six (6) residents.



On 10/16/2023, the local fire authority approved/granted an updated fire clearance, reflecting the facility was approved for six (6) residents in total, of which one (1) resident may be bedridden and five (5) residents may be non-ambulatory. This fire clearance specified that the bedridden resident may only be assigned to Bedroom #4, per the facility sketch.

During today's visit, LPA toured the interior and exterior of the facility, observed residents, review medical records, and interviewed the licensee.

Per LPA observation, staff interviews, and review of the residents' care records: there was 1 bedridden and 5 non-ambulatory residents in care on the date of LPA's visit. The one bedridden resident was assigned to Bedroom #4, consistent with the new fire clearance. The updated facility sketch/floor plan was consistent with the current layout of the facility. The Licensee displayed comprehension of the terms of their new facility fire clearance.

No deficiencies were cited during today's visit.

[CONTINUED ON LIC 809-C]
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SAY YOU'RE HOME
FACILITY NUMBER: 374604456
VISIT DATE: 10/18/2023
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[CONTINUED FROM LIC 809-C]

This portion of the application process has been completed. The Licensee will be sent an updated license to reflect the new fire clearance after CCLD management’s final review and approval.

An exit interview was conducted with Sayre, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2023
LIC809 (FAS) - (06/04)
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