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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604632
Report Date: 12/07/2023
Date Signed: 12/07/2023 12:56:23 PM

Document Has Been Signed on 12/07/2023 12:56 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:LOVE FIRST RESIDENCES #1FACILITY NUMBER:
374604632
ADMINISTRATOR:O'CONNELL, MICHELLEFACILITY TYPE:
735
ADDRESS:1338 BOSWORTH STTELEPHONE:
(619) 312-5299
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY: 6CENSUS: 6DATE:
12/07/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator Michelle O'ConnellTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Administrator Michelle O’Connell.

Today's visit was in response to licensee’s self-reported death of Client #1 (C1), received at the CCLD San Diego Regional Office on 11/27/2023. [See LIC 811 Confidential Names List for a description of C1]. Per the report, C1 passed away on 11/23/2023.

During today’s visit, LPA performed a brief facility tour. The remaining clients in care were all off-site at day programs during LPA's visit, so a welfare check could not be performed. LPA collected copies of and reviewed pertinent records, and interviewed relevant staff.

No deficiencies were observed or cited during today’s visit.

An exit interview was conducted with O’Connell, to whom a copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 12/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/07/2023
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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