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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604323
Report Date: 01/18/2022
Date Signed: 01/18/2022 11:20:14 AM

Document Has Been Signed on 01/18/2022 11:20 AM - 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:SILVERGATE RANCHO BERNARDOFACILITY NUMBER:
374604323
ADMINISTRATOR:BRAKEVILLE, SONDRAFACILITY TYPE:
740
ADDRESS:16061 AVENIDA VENUSTOTELEPHONE:
(858) 451-1100
CITY:SAN DIEGOSTATE: CAZIP CODE:
92128
CAPACITY: 285CENSUS: 205DATE:
01/18/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:04 AM
MET WITH:Jessica Swaaley, Business Office ManagerTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Carmen Lopez and County of San Diego COVID-19 Site Assessment Nurse, Jennifer West, with the Healthcare - Associated Infections (HAI) Program, conducted an on-site HAI assessment visit. LPA and team identified themselves and discussed the purpose of the visit with Jessica Swaaley, Business Office Manager.

The Department conducted an on-site visit to provide technical assistance and to evaluate the facility's mitigation plan to include disinfection, testing, vaccination, and screening protocols as well as the use of personal protective equipment (PPE). During today's visit, the team interviewed the Business Office Manager and conducted a walk-though of the facility. A debriefing was conducted with the Business Office Manager at the conclusion of the visit.

During today's visit, no deficiencies were cited. An exit interview was conducted with the Business Office Manager Swaaley to whom a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided via electronic mail. An electronic receipt of confirmation was requested upon receipt of the documents.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2022
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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