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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604722
Report Date: 09/24/2024
Date Signed: 09/24/2024 01:12:28 PM


Document Has Been Signed on 09/24/2024 01:12 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:NOVELLUS CLAIREMONT LLCFACILITY NUMBER:
374604722
ADMINISTRATOR:LAIRD, CANDIFACILITY TYPE:
740
ADDRESS:5219 CLAIREMONT MESA BLVD.TELEPHONE:
(858) 292-8044
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY:214CENSUS: 83DATE:
09/24/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Emily De La Barre and Mercedes HerediaTIME COMPLETED:
01:25 PM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Case Management visit. The LPA identified himself and disclosed the purpose of the visit to Business Office Manager Mercedes Heredia. Executive Director Emily De La Barre arrived during the visit and assisted the LPA.

Today's visit was in response to an Unusual Incident Report (LIC 624) submitted to the Department on August 28th, 2024. The LIC 624 reported Resident # 1 (R1) had left the and was considered AWOL. During the visit, the LPA requested pertinent records and conducted interviews.

Review of records, along with the interviews of staff and R1, confirmed the facility followed the facility's elopement procedures. There were no deficiencies cited on today's date.

An exit interview was conducted with Executive Director De La Barre, to whom a copy of this report, LIC 811, and Licensee/Appeal Rights (LIC 9058), were provide.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/24/2024
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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