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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604681
Report Date: 01/24/2024
Date Signed: 01/24/2024 12:27:58 PM

Document Has Been Signed on 01/24/2024 12:27 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:WINGS RECOVERY CENTER LLCFACILITY NUMBER:
374604681
ADMINISTRATOR:HOSLAR, KATYFACILITY TYPE:
775
ADDRESS:785 GRAND AVE SUITE 101 & 102TELEPHONE:
(858) 220-9519
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY: 30CENSUS: DATE:
01/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
MET WITH:Chief Operating Officer Katy HoslarTIME COMPLETED:
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Licensing Program Analysts (LPAs) Juliana Barfield and Dang Nguyen conducted an unannounced Case Management - Incident visit. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit with Chief Operating Officer Katy Hoslar.

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 1/23/2024. [See LIC 811 Confidential Names List for a description of C1]. Per the report, C1 passed away on 1/21//2024.

During today's visit, LPAs collected copies of and reviewed pertinent records and interviewed relevant staff.

No deficiencies were cited during today's visit.

An exit interview was conducted with Hoslar, 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: Juliana Barfield
LICENSING EVALUATOR SIGNATURE: DATE:
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE:
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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