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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600658
Report Date: 04/26/2023
Date Signed: 04/26/2023 02:17:27 PM

Document Has Been Signed on 04/26/2023 02:17 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:R & R RESIDENTIAL CARE FOR ELDERLY #2FACILITY NUMBER:
374600658
ADMINISTRATOR:REMELITO REYESFACILITY TYPE:
740
ADDRESS:9121 MESA WOODS AVENUETELEPHONE:
(858) 735-8139
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY: 5CENSUS: 5DATE:
04/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Licensee Teresita ReyesTIME COMPLETED:
02:20 PM
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management Visit to observe the physical plant. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Licensee Teresita Reyes.

On 01-29-2023, the Licensee submitted an LIC200 Application to the CCLD San Diego Regional Office (RO) to increase the facility's total licensed capacity from five (5) residents up to six (6) residents, of which all may be non-ambulatory and one (1) may be bedridden. This request did not involve changing the facility’s floor plan.



On 04-11-2023, the local fire authority approved/granted an updated fire clearance, reflecting the facility was approved for six (6) residents in total, of which all may be non-ambulatory and one (1) may be bedridden.

During today's visit, LPA conducted a brief tour to verify that the facility sketch/floor plan was consistent with the current layout of the facility. Licensee confirmed understanding the terms of their new fire clearance. No deficiencies were observed or cited.

This portion of the application process has been completed. The Licensee will be sent an updated license to reflect the new fire clearance after CCLD management’s final review and approval.

An exit interview was conducted with Reyes, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2023
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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