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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372004836
Report Date: 03/21/2024
Date Signed: 03/25/2024 03:19:34 PM

Document Has Been Signed on 03/25/2024 03:19 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:R & R RESIDENTIAL CARE FOR ELDERLYFACILITY NUMBER:
372004836
ADMINISTRATOR:REM RYAN REYESFACILITY TYPE:
740
ADDRESS:10255 THANKSGIVING LANETELEPHONE:
(858) 271-9349
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY: 5CENSUS: DATE:
03/21/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:25 AM
MET WITH:Caregiver Emilita Garcia BTIME COMPLETED:
10:40 AM
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Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced Case Management visit today 3/25/24 at approximately 3:15pm to amend a report that was incorrectly generated on 3/21/24 for another facility. No deficiencies were issued during this visit.

An exit interview was conducted over the phone with Administrator, Rem Ryan Reyes and in person with Caregiver Emilita Garcia B to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE: DATE: 03/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/25/2024
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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