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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602480
Report Date: 01/02/2025
Date Signed: 01/02/2025 02:28:14 PM

Document Has Been Signed on 01/02/2025 02:28 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:SAGE GARDEN AT RANCHO BERNARDO, THEFACILITY NUMBER:
374602480
ADMINISTRATOR/
DIRECTOR:		MARY JANE ESTILLERFACILITY TYPE:
740
ADDRESS:12295 FRONTERA RDTELEPHONE:
(858) 716-3947
CITY:SAN DIEGOSTATE: CAZIP CODE:
92128
CAPACITY: 6CENSUS: 5DATE:
01/02/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Maria Rina Chang, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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) Nacole Patterson conducted an unannounced Case Management Visit.  LPA was greeted by and met with Administrator Maria Rina Chang, to discuss the purpose of the visit. 

Today's visit is in response to the self reported death of Resident 1 (R1 - see LIC811 Confidential Names List). R1 passed away on 10/11/24.

LPA conducted a wellness check at the facility; no health or safety issues were identified. No deficiencies were cited or observed on this date. 

An exit interview was conducted with Administrator Maria Rina Chang, who was provided with a copy of this report and Appeal Rights (LIC9056 03/22). Their signature confirms receipt of these documents.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Nacole Patterson
LICENSING EVALUATOR SIGNATURE: DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/02/2025
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