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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 134602495
Report Date: 10/26/2023
Date Signed: 10/26/2023 12:03:51 PM


Document Has Been Signed on 10/26/2023 12:03 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:CASA ELITEFACILITY NUMBER:
134602495
ADMINISTRATOR:IRMA PINEDAFACILITY TYPE:
740
ADDRESS:1785 CITRUS LANETELEPHONE:
(760) 352-9591
CITY:EL CENTROSTATE: CAZIP CODE:
92243
CAPACITY:8CENSUS: 6DATE:
10/26/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Caregiver Veronica NaranjoTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced Case management visit. The LPA identified himself, and explained the purpose of the visit to Caregiver Veronica Naranjo.

During today's visit, the LPA secured report signatures and delivered an amended report.

An exit interview was conducted with Naranjo, to whom a copy of this report and the licensee appeal rights (LIC9058) were provided.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2023
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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