<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604845
Report Date: 01/09/2025
Date Signed: 01/09/2025 10:34:18 AM

Document Has Been Signed on 01/09/2025 10:34 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:SIGNATURE ADULT CAREFACILITY NUMBER:
374604845
ADMINISTRATOR/
DIRECTOR:		EDWARDS, RICHARDFACILITY TYPE:
735
ADDRESS:257 GARRETT AVETELEPHONE:
(619) 954-0963
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY: 6CENSUS: 0DATE:
01/09/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:18 AM
MET WITH:Richard EdwardsTIME VISIT/
INSPECTION COMPLETED:
10:57 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Ramon Serrano, conducted an announced Pre-Licensing inspection. LPA met with Licensee Richard Edwards and we discussed the purpose of the visit. Their were zero clients in care at the time of visit.

LPA conducted a tour of the facility, both inside and outside. There are no pools on site. The smoke and carbon monoxide alarms were present. Toilets intended for client use were operating as intended, and bathing facilities were observed to be clean and kempt. The windows, curtains and paint throughout the facility, was observed in good condition. Each room intended for client use had the appropriate furniture, bedding and appropriate lighting. Licensee stated there are no firearms stored on the premises.

The facility was observed to be clean and kempt with no strong malodors. Both hot water temperature and ambient temperature of the facility were at compliant readings. The refrigerator and freezer was observed to be clean and operational, with an ample amount of food to meet client needs. Cleaning solutions were also properly secured in the storage room.

The Component III portion of the application process was completed with Licensee Richard Edwards today's date as well.

Pre-Licensing is complete and this facility has no deficiencies. An exit interview was conducted with Richard Edwards and a copy of this report along with Licensee Rights was provided to Richard Edwards whose signature below verifies receipt of these.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1