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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604632
Report Date: 06/12/2024
Date Signed: 03/06/2025 02:05:45 PM

Document Has Been Signed on 03/06/2025 02:05 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:LOVE FIRST RESIDENCES #1FACILITY NUMBER:
374604632
ADMINISTRATOR/
DIRECTOR:		O'CONNELL, MICHELLEFACILITY TYPE:
735
ADDRESS:1338 BOSWORTH STTELEPHONE:
(619) 312-5299
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY: 6CENSUS: 6DATE:
06/12/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:45 PM
MET WITH:House Manager Mike GoodwinTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Case Management visit to follow-up on an incident reported to Community Care Licensing. LPA met with House Manager Mike Goodwin, and we discussed the purpose of the visit.

Community Care Licensing received an incident report on 6/7/24 in which it was reported that Client (C1) left from the facility on 6/5/24 and had not returned.Per records reviewed C1 can leave facility unassisted. Per House Manager C1 returned as of 6/6/24 in the afternoon.

During today's visit, LPA conducted a health and safety check of the clients in care and provided consultation. No deficiencies were cited during today’s visit.

An exit interview was conducted with House Manager Mike Goodwin, who was also provided a copy of their appeal rights (LIC9058 03/22), this report and their signature on this form, acknowledges receipt of these rights.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE: DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/12/2024
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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