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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604831
Report Date: 09/18/2024
Date Signed: 09/19/2024 12:07:48 PM


Document Has Been Signed on 09/19/2024 12:07 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:ASSISTED LIVING AT WOODBURNFACILITY NUMBER:
374604831
ADMINISTRATOR:ESSERY, RICHARDFACILITY TYPE:
740
ADDRESS:1727 WOODBURN STTELEPHONE:
(858) 263-5626
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY:6CENSUS: 0DATE:
09/18/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Licensees Richard Essery and Cheryl CataniaTIME COMPLETED:
05:00 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 Licensees Richard Essery and Cheryl Catania.

During today’s visit, LPA, accompanied by Richard and Cheryl, 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 Richard and Cheryl, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided to the Licensees.

NOTE: LPA left the facility for a 1 hour lunch break and came back to complete the visit.

SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 767-2311
LICENSING EVALUATOR NAME: Liliana SilveiraTELEPHONE: (619) 481-0844
LICENSING EVALUATOR SIGNATURE:
DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/18/2024
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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