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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372004250
Report Date: 04/23/2021
Date Signed: 04/23/2021 11:08:31 AM

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 CARE HOMEFACILITY NUMBER:
372004250
ADMINISTRATOR:ERNESTO CABANASFACILITY TYPE:
740
ADDRESS:1303 MISSOURI STREETTELEPHONE:
(760) 439-2262
CITY:OCEANSIDESTATE: CAZIP CODE:
92054
CAPACITY:6CENSUS: 5DATE:
04/23/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:33 AM
MET WITH:Caregiver, Janet CraigTIME COMPLETED:
10:59 AM
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Licensing Program Analyst (LPA), Kristina Ryan, initiated an unannounced case management visit to provide technical assistance and review the facilities COVID-19 mitigation plan. The virtual visit was conducted via FaceTime due to COVID-19 restrictions. LPA met with Caregiver, Janet Craig, identified herself, and stated the purpose of the virtual visit.


During today's visit, LPA toured the facility and interviewed staff. No deficiencies were issued during this visit.

An exit interview was conducted. A copy of this report and Licensee's Rights (9058 01/16) were provided to the Administrator, Ernesto Cabanas via electronic mail. An email receipt confirms the acknowledgement of these documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Kristina RyanTELEPHONE: (619) 929-1438
LICENSING EVALUATOR SIGNATURE:

DATE: 04/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2021
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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