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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604501
Report Date: 10/07/2024
Date Signed: 10/07/2024 10:52:15 AM

Document Has Been Signed on 10/07/2024 10:52 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:DEL REY SPRINGSFACILITY NUMBER:
374604501
ADMINISTRATOR/
DIRECTOR:		GONZALEZ, EDUARDOFACILITY TYPE:
735
ADDRESS:1181 PLAZA AMPARADATELEPHONE:
(619) 990-8870
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 4CENSUS: 3DATE:
10/07/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:29 AM
MET WITH:Roxana RiosTIME VISIT/
INSPECTION COMPLETED:
11:19 AM
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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced Case Management Visit.  LPA was greeted by and met with Direct Service Professional Roxana Rios, to discuss the purpose of the visit. 

Today's visit is in response to the self reported incidents of Client 1 (C1 - see LIC811 Confidential Names List) who AWOL'd from community outings on October 2nd and 3rd, 2024.

LPA interviewed facility staff and obtained facility records. No deficiencies were cited or observed on this date. 

An exit interview was conducted with Roxanna Rios who was provided with a copy of this report and Appeal Rights. Their signature confirms receipt of these documents.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE: DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/07/2024
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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