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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881145
Report Date: 04/08/2024
Date Signed: 04/08/2024 09:18:06 AM


Document Has Been Signed on 04/08/2024 09:18 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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:MILEY'S ANGEL HOME CARE, LLCFACILITY NUMBER:
361881145
ADMINISTRATOR:AZAULA, MILAGROSFACILITY TYPE:
740
ADDRESS:16510 GALA AVETELEPHONE:
(909) 428-1824
CITY:FONTANASTATE: CAZIP CODE:
92337
CAPACITY:6CENSUS: 5DATE:
04/08/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Milagros Azaula, Licensee/AdministratorTIME COMPLETED:
09:20 AM
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Licensing Program Manager (LPM) Tricia Danielson and Licensing Program Analyst (LPA) Sara Martinez arrived unannounced to the facility to conduct a collateral visit regarding two (2) complaint investigations which are unrelated to this facility. LPM and LPA met with Milagros Azaula and explained the purpose of the visit.
Complaint Control #18-AS-20201124140635 concern allegations of unlicensed care being provide at this address by a former occupant of this address and #18-AS-20201124133053 concern allegations made against the previous licensee who operated a facility at this address. During today's visit, LPM and LPA verified the current licensee purchased the business from Adelaida Legaspi in April 2021 and obtained a license to provide care and supervision on June 21, 2021. Azaula reported she has been in operation since that date.
There are no concerns or deficiencies noted during today's visit. An exit interview was conducted and a copy of this report was provided to Azaula.
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: 951-202-5067
LICENSING EVALUATOR SIGNATURE:
DATE: 04/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/08/2024
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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