374601847-4-26-2021-08-AS-LSIA-C2FVAZ-20210426161646

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374601847
Report Date: 04/23/2021
Date Signed: 04/26/2021 04:22:45 PM

Document Has Been Signed on 04/26/2021 04:22 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:	SECURE SENIORS		FACILITY NUMBER:	374601847
ADMINISTRATOR:	SANDY KRASOVEC		FACILITY TYPE:	740
ADDRESS:	836 EAGLES NEST GLEN		TELEPHONE:	(760) 746-5123
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92027
CAPACITY: 16		CENSUS: 14	DATE:	04/23/2021
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME BEGAN:	09:09 AM
MET WITH:	Sandy Krasovec- Administrator		TIME COMPLETED:	10:04 AM

NARRATIVE

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Licensing Program Analyst (LPA) Liliana Silveira conducted a virtual case management visit via FaceTime to provide technical assistance and review the facility COVID-19 Mitigation Plan Report. LPA identified herself and discussed the purpose of the conference call with Administrator Sandy Krasovec.

During today's visit, LPA toured the facility and interviewed the Administrator. LPA inspected the facility’s screening areas, observed their sanitation supplies as well as PPE supplies. No deficiencies were issued during this visit.

An exit interview was conducted with Administrator Sandy Krasovec and a copy of this report, along with Licensee Rights (LIC 9058 01/16), was provided to her via email. An email receipt confirms the acknowledgement of these documents.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2021

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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