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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603344
Report Date: 12/03/2024
Date Signed: 12/03/2024 04:47:24 PM

Document Has Been Signed on 12/03/2024 04:47 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:A WINSOME ASSISTED LIVING COMMUNITYFACILITY NUMBER:
374603344
ADMINISTRATOR/
DIRECTOR:		GUIA IGBANTE-ENRIQUEZFACILITY TYPE:
740
ADDRESS:3808 SWEETWATER ROADTELEPHONE:
(619) 434-6560
CITY:BONITASTATE: CAZIP CODE:
91902
CAPACITY: 6CENSUS: 6DATE:
12/03/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:25 PM
MET WITH:House Manager, Jessica EnriquezTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted a case management visit after
completing the annual inspection. LPA identified herself and was granted entry by Caregiver, Irma Sunga, to whom she disclosed the purpose of the visit.

During the case management visit LPA Garcia-Centeno discussed the age requirement for residents living at the RCFE. The licensee agreed to submit formal request to CCL for age exception. LPA outlined the procedures for submitting a request to CCL.

No violations were cited during today's visit.

An exit interview was conducted with House Manager, Irma Sunga, to whom a copy of this report, and the
Licensee/Appeal Rights (LIC9058 03/22) were provided at the end of the visit.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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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