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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604818
Report Date: 08/07/2024
Date Signed: 08/09/2024 01:53:40 PM


Document Has Been Signed on 08/09/2024 01:53 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:EPIC ASSISTANCE CARE HOME 4FACILITY NUMBER:
374604818
ADMINISTRATOR:MESDJIAN, LIZAFACILITY TYPE:
740
ADDRESS:1061 E BRADLEY AVETELEPHONE:
(818) 220-0282
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY:15CENSUS: 13DATE:
08/07/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Assistant Administrator Silvana HuertaTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Liliana Silveira conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted by, identified herself to, and explained the purpose of the visit to the applicant’s representative, Assistant Administrator Silvana Huerta.

During today’s visit, LPA, accompanied by Silvana, toured the interior and exterior of the facility and inspected each room. There are items which must be corrected for the facility to comply with regulation(s). The applicant did not pass the pre-licensing inspection, and a return visit will be required.



An exit interview was conducted with Silvana, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 767-2311
LICENSING EVALUATOR NAME: Liliana SilveiraTELEPHONE: (619) 481-0844
LICENSING EVALUATOR SIGNATURE:
DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/07/2024
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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