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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604632
Report Date: 01/26/2024
Date Signed: 01/26/2024 05:05:09 PM

Document Has Been Signed on 01/26/2024 05:05 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:
01/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Administratror Michelle O'ConnellTIME COMPLETED:
05:10 PM
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Licensing Program Analysts (LPAs) Dang Nguyen and Juliana Barfield conducted an unannounced Case Management - Incident visit. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit with Administrator Michelle O’Connell.

Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office (received on 01/22/2024). According to the LIC624: on 01/14/2024, Client #1 (C1) left the facility, and then returned two hours later on their own, during which time staff had called local police. C1 was unharmed. [See LIC 811 Confidential Names List for a description of C1.]

During today’s visit, LPAs performed a facility tour and welfare check on C1 and their housemates, verifying all were safe. LPAs also reviewed and collected copies of pertinent records and interviewed relevant staff.

According to their latest LIC602 Physician’s Report (dated 12/14/2023), C1’s was diagnosed with an intellectual disability, but their doctor also determined that C1 was not confused, able to follow instructions, able to communicate needs, and able to safely leave the facility unassisted. San Diego Regional Center (SDRC) documents also corroborated that C1 was able to manage themselves safely in the outside community.

Records review and interviews showed: Licensee’s staff saw C1 as they departed the facility, but C1 declined to tell staff where they were going or when they planned to come back. Licensee had an Absentee Notification Plan as part of the written record care for C1, as was required.

No deficiencies were cited during today's visit.

[CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2024
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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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: LOVE FIRST RESIDENCES #1
FACILITY NUMBER: 374604632
VISIT DATE: 01/26/2024
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[CONTINUED FROM LIC 809]

LPAs issued one (1) Technical Violation (TV) regarding eviction procedures. LPA also provided Technical Assistance (TA) regarding clients’ personal rights and auditory devices on exterior doors.

An exit interview was conducted with O’Connell, to whom a copy of this report, the LIC9102-TV, the LIC9102-TA pages, 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: 01/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024
LIC809 (FAS) - (06/04)
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