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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604689
Report Date: 10/03/2024
Date Signed: 10/03/2024 04:24:26 PM

Document Has Been Signed on 10/03/2024 04:24 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:PARKER VILLAFACILITY NUMBER:
374604689
ADMINISTRATOR/
DIRECTOR:
LYNN DRUMMONNFACILITY TYPE:
740
ADDRESS:629 MICHAEL STTELEPHONE:
(619) 625-6886
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY: 6CENSUS: 5DATE:
10/03/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:05 PM
MET WITH:Caregiver Raymond AbedozaTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced case management visit to conduct follow up regarding an incident report. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Raymond Abedoza. Administrator Lynn Drummond arrived during the visit.

On 9/13/2024, the Department received an incident report from the facility regarding Resident 1 (R1). [Administrator was provided with an LIC811 Confidential Names List to identify R1] The incident report stated that on 9/7/2024, R1 decided to move out of the facility and into a private dwelling and left in a ride-share vehicle. Review of records received from the facility revealed that on 7/17/2024, R1 had been issued a 30-day eviction notice in which the 30-day ended on 8/16/2024. During a licensing visit on 8/22/2024 and contacts from facility staff and outside sources, the Department confirmed that R1 had not relocated to alternate placement.

During today’s visit, LPA observed residents in care, reviewed and obtained copies of facility records, and interviewed staff and residents. LPA confirmed that R1 was not present at the facility and the facility did not contain any of R1's personal belongings.

No deficiencies were cited on today’s date. An exit interview was conducted with Administrator Lynn Drummond, whose signature below confirms receipt of a copy of this report, the LIC811, and the Licensee Appeal Rights (LIC9058 3/22).
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 10/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/03/2024
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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