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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372002165
Report Date: 04/25/2022
Date Signed: 04/25/2022 01:06:38 PM


Document Has Been Signed on 04/25/2022 01:06 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:CABANAS ADULT CARE HOMEFACILITY NUMBER:
372002165
ADMINISTRATOR:CABANAS, ERLOVEFACILITY TYPE:
740
ADDRESS:8031 MONTARA AVENUETELEPHONE:
(858) 689-1872
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY:5CENSUS: 0DATE:
04/25/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator, Erlove CabanasTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA), Natasha Persaud conducted a Case Management - Other visit. LPA was greeted and allowed entry into the facility by Administrator, Erlove Cabanas. The purpose of the visit was regarding licensee requesting closure of facility.

Community Care Licensing received a letter dated 03/07/22 from the licensee stating the facility is closing, due to ever-rising operational cost and declining health of licensee. The letter stated they will close as of 06/01/22. As of 04/04/22, all residents have been relocated. The facility would like to close effective immediately.

During today's visit, LPA toured the facility and observed there were no residents in care. All licensing postings have been removed. LPA obtained the original license. No deficiencies were issued, and the facility is ready for closure.

An exit interview was conducted with Administrator and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided to the Administrator, Erlove Cabanas.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:
DATE: 04/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/25/2022
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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