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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604524
Report Date: 01/24/2024
Date Signed: 01/24/2024 04:02:01 PM


Document Has Been Signed on 01/24/2024 04:02 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:AUTUMN VILLAS ON HONORS DRIVE, LLCFACILITY NUMBER:
374604524
ADMINISTRATOR:KANAN, KARENFACILITY TYPE:
740
ADDRESS:5874 HONORS DRIVETELEPHONE:
(858) 750-2021
CITY:SAN DIEGOSTATE: CAZIP CODE:
92122
CAPACITY:6CENSUS: 6DATE:
01/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Administrator's Assistant Meredith Pritchardmalo, and Caregiver Danielle ThurmanTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPAs) Sabel Martinez conducted an unannounced visit to conduct a Required Annual Inspection. The facility file was reviewed prior to the visit. The LPA introduced himself and disclosed the purpose of the visit to Caregiver Danielle Thurman. Administrator assistant Meredith Pritchardmalo arrived during the visit and assisted the LPA.

During today’s visit, The LPA toured the facility, and reviewed staff and resident records. No deficiencies were cited during today’s visit. Due to time constraints, a return visit on a subsequent day is needed to complete the annual inspection.

An exit interview was conducted with the Pritchardmalo, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058), were provided

SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2024
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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