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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370802865
Report Date: 11/24/2024
Date Signed: 11/24/2024 02:07:06 PM

Document Has Been Signed on 11/24/2024 02:07 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:ORLANDO GUEST HOMEFACILITY NUMBER:
370802865
ADMINISTRATOR/
DIRECTOR:		CYRALYNN MABALOTFACILITY TYPE:
735
ADDRESS:297 -299 ORLANDOTELEPHONE:
(619) 444-9411
CITY:EL CAJONSTATE: CAZIP CODE:
92021
CAPACITY: 34CENSUS: 32DATE:
11/24/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Caregiver Maria HerreraTIME VISIT/
INSPECTION COMPLETED:
02:10 PM
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Collateral Visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Maria Herrera.

During today’s visit, LPA interviewed a client in care, to aid in an investigation involving a different licensed care facility.

No deficiencies were observed or cited during today's visit.

An exit interview was conducted with Herrera, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 11/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/24/2024
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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