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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005729
Report Date: 10/19/2023
Date Signed: 10/19/2023 10:13:18 AM


Document Has Been Signed on 10/19/2023 10:13 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:CARE AYESHAFACILITY NUMBER:
306005729
ADMINISTRATOR:DEL ROSARIO, LESTERFACILITY TYPE:
740
ADDRESS:452 S SWIDLER PLACETELEPHONE:
(657) 281-2103
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY:6CENSUS: 5DATE:
10/19/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Angie Hernandez, Licensee and Chris Salondaga, CaregiverTIME COMPLETED:
10:12 AM
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On today's date, Licensing Program Analyst (LPA) Rosie Quiroz and Licensing Program Manager (LPM) Alisa Ortiz conducted an unannounced collateral visit. LPA Quiroz and LPM Ortiz were greeted and granted entry by Caregiver Chris Salondaga and met with Licensee Angie Hernandez and discussed the purpose of today's visit to conduct interviews in regards to the following complaint control numbers:
  • #22-AS-20231010115905
  • #22-AS-20230413150926
  • #22-AS-20220621095243
  • #22-AS-20230317093401
  • #22-AS-20230919143528

During today's visit on or about 9:45am, LPA Quiroz along with Licensee Angie Hernandez conducted a facility tour inspection of the interior and exterior of facility premises.

There were no deficiencies issued during this Collateral visit.

An exit interview was conducted with Licensee Angie Hernandez and a copy of this report was provided at exit.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2023
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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