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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604799
Report Date: 07/02/2024
Date Signed: 07/09/2024 09:11:31 AM

Document Has Been Signed on 07/09/2024 09:11 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:DEHESA VIEW MANORFACILITY NUMBER:
374604799
ADMINISTRATOR/
DIRECTOR:
AGREGADO, RUCHELLEFACILITY TYPE:
740
ADDRESS:5610 DEHESA RD.TELEPHONE:
(760) 481-8238
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY: 6CENSUS: 0DATE:
07/02/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Licensee Joseph LiTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) Iby Strong, conducted an announced Pre-Licensing inspection. LPA met with Licensee Joseph Li and discussed the purpose of the visit. Administrator Ruchelle Agregado was present via telephone speaker.

LPA conducted a tour of the facility, both inside and outside. This facility is a two story building. The second story is used as a storage area and is not intended for resident use, please see facility sketch. There are no pools on site. The smoke alarm and fire extinguishers were present. Toilets intended for resident use were operating as intended, and bathing facilities were observed to be clean and kempt. The windows and paint throughout the facility, were observed in good condition. Each room intended for resident use had the appropriate furniture, bedding and appropriate lighting. Licensee stated there are no firearms stored on the premises.

Hot water temperature was measured in the facility at 108.0 degrees F. The ambient temperature inside the facility was measured at 75 degrees F. The facility was observed to be clean and kempt with no malodors. The refrigerators and freezers were observed to be clean and operational. Cleaning solutions were also properly secured in the storage rooms.

The Component III portion of the application process was completed with Licensee Joseph Li and Ruchelle Agredago on today's date as well.

Pre-Licensing is complete and this facility has no deficiencies. An exit interview was conducted. The Applicant will be provided a copy of their Appeal/Licensee rights (LIC9058) and this report on todays date.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE: DATE: 07/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2024
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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