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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604783
Report Date: 06/18/2024
Date Signed: 06/19/2024 07:53:14 AM

Document Has Been Signed on 06/19/2024 07:53 AM - 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:JANNA RESIDENTIALFACILITY NUMBER:
374604783
ADMINISTRATOR/
DIRECTOR:		PHILLIPS, ARIANEFACILITY TYPE:
735
ADDRESS:1144 ST GEORGE DRTELEPHONE:
(619) 736-7115
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY: 3CENSUS: 0DATE:
06/18/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:05 PM
MET WITH:Administrator Ariane PhillipsTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Iby Strong, conducted an announced Pre-Licensing inspection. LPA met with Administrator Ariane Phillips and discussed the purpose of the visit.

LPA conducted a tour of the facility, both inside and outside. Fire clearance has been granted for 3 ambulatory clients. During today's visit, LPA observed there is an open bank on the property used to guide water during rainy season and there is nothing making this area inaccessible to clients. In addition, the flooring between the hallway and bedrooms are incomplete, there are portions of the walls that have been patched but not painted, and some doorway frames are not fully attached. Lastly, the dining area has multiple items restricting usage of the area and one client bedroom has a bed intended for a small child. As of today, the Pre-Licensing is incomplete. A follow up visit is required to complete the pre-licensing inspections.

An exit interview was conducted. The Applicant will be provided a copy of their Appeal/Licensee rights (LIC9058 03/22) and this report on todays date.


SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE: DATE: 06/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/18/2024
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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