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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604574
Report Date: 04/19/2022
Date Signed: 04/19/2022 04:41:33 PM

Document Has Been Signed on 04/19/2022 04:41 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:LIVE AND CAREFACILITY NUMBER:
374604574
ADMINISTRATOR:TURNER, ANGIEFACILITY TYPE:
735
ADDRESS:861 REBECCA DRIVETELEPHONE:
(619) 588-6372
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY: 4CENSUS: 0DATE:
04/19/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
02:39 PM
MET WITH:Angie Turner, ApplicantTIME COMPLETED:
03:14 PM
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Licensing Program Analyst (LPA) Dawn Segura conducted an announced pre-licensing visit to follow-up on a previous pre-licensing visit that was conducted to observe the facility’s physical plant for compliance with Title 22, Division 6, Chapter 8 of California Code of Regulations and Health & Safety Code. LPA was granted entry and met with Angie Turner, Applicant.

The facility fire clearance was granted on March 3, 2022 and reflects that the facility is approved for four (4) ambulatory clients.

During today’s visit, LPA observed that the hot water temperature in the bathroom to be used by clients measured at 105.3 degrees F.

Item reviewed during today's visit is in compliance with Title 22, Division 6, Chapter 8 of California Code of Regulations, and applicant has passed the pre-licensing inspection. Applicant was advised that the application is pending management final review and approval. This report was discussed with the applicant, and a copy of the report and Applicant Rights (LIC 9058) will be provided to Angie Turner, via email, following the conclusion of the visit.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE: DATE: 04/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/19/2022
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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