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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604734
Report Date: 06/19/2024
Date Signed: 06/19/2024 02:13:15 PM

Document Has Been Signed on 06/19/2024 02:13 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
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:CHANGING OPTIONSFACILITY NUMBER:
374604734
ADMINISTRATOR/
DIRECTOR:		MELCHER, JENNIFERFACILITY TYPE:
735
ADDRESS:500 3RD STREETTELEPHONE:
(714) 224-0826
CITY:RAMONASTATE: CAZIP CODE:
92065
CAPACITY: 14CENSUS: 14DATE:
06/19/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Jennifer Melcher, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced Case Management visit to deliver an amended LIC9099 Complaint Investigation Report, with deficiencies and plan of correction. LPA identified himself, was granted entry, and stated the purpose of the visit to Jennifer Melcher, Administrator.

During the visit, LPA toured the facility, interviewed staff and clients and delivered the amended LIC9099 which was previously delivered to the licensee's representative on May 22, 2024. No deficiencies were observed and no citations were issued as a result of observations made during todat's visit.

An exit interview was conducted with Jennifer Melcher, Administrator. A copy of this report and Licensee Appeal Rights (9058 03/22) were provided to Ms. Melcher after the conclusion of the visit,
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Daniel Pena
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2024
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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