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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600188
Report Date: 02/13/2023
Date Signed: 02/13/2023 10:00:08 AM

Document Has Been Signed on 02/13/2023 10:00 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:AQUINO'S QUALITY HOMECAREFACILITY NUMBER:
374600188
ADMINISTRATOR:FELICIDAD M. AQUINOFACILITY TYPE:
735
ADDRESS:598 IVY COURTTELEPHONE:
(619) 482-6897
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 6CENSUS: 5DATE:
02/13/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Caregiver, Eufrosina HernandezTIME COMPLETED:
10:10 AM
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Licensing Program Analyst (LPA) Elizabeth Hamilton made an unannounced visit to the facility to conduct a Plan of Correction (POC) visit to verify the corrections of deficiencies cited on January 10, 2023. LPA was met by at the front entrance by Caregiver, Eufrosina Hernandez, LPA identified herself, and was granted entry into facility. LPA explained the purpose of the visit.

During today's visit, LPA toured the facility and observed cited areas. A one-week extension until February 21, 2023, was provided to complete the plan of correction.

This report was discussed with Caregiver, Eufrosina Hernandez. A copy of this report, along with Licensee/Appeal Rights, was provided.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Elizabeth Hamilton
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2023
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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