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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372004561
Report Date: 12/09/2024
Date Signed: 12/09/2024 10:20:56 AM

Document Has Been Signed on 12/09/2024 10:20 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 DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:MAILE ALOHAFACILITY NUMBER:
372004561
ADMINISTRATOR/
DIRECTOR:		PEREZ, JOSEPHINE A.FACILITY TYPE:
740
ADDRESS:3636 CHRISTINE STREETTELEPHONE:
(858) 274-0921
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY: 12CENSUS: 7DATE:
12/09/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Staff Marcela BecerraTIME VISIT/
INSPECTION COMPLETED:
10:35 AM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Plan of Correction visit. The LPA introduced himself and disclosed the purpose of the visit to Staff Marcela Becerra.

On 11/25/2024, during an annual inspection the LPA cited a fire clearance violation. Today, the LPA confirmed the facility had not completed the agreed upon Plan of Correction by the due date of 11/26/2024. Additional civil penalties in the amount of fourteen hundred dollars ($1,400) were cited in an LIC 421FC form.
An exit interview was conducted with Staff Marcela Becerra, to whom a copy of this report, LIC 421FC form, and the Licensee Rights (LIC 9058) form, were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/09/2024
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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