<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600397
Report Date: 06/23/2023
Date Signed: 07/05/2023 11:13:26 AM

Document Has Been Signed on 07/05/2023 11:13 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:LYN'S HOME CARE IIFACILITY NUMBER:
374600397
ADMINISTRATOR:LYDIA S. ABILLEFACILITY TYPE:
735
ADDRESS:1365 EL LUGAR STREETTELEPHONE:
(619) 427-1830
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 6CENSUS: 6DATE:
06/23/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Staff, Victoria AzucenaTIME COMPLETED:
12:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced Plan of Correction (POC) visit. LPA was greeted and allowed entry into the facility. LPA met with Staff, Victoria Azucena.

On 05/24/23, the facility was issued a deficiency regarding buildings and grounds. Staff agreed to clean the facility and replace a battery in smoke detector by POC due date 06/21/23. Today, LPA verified the facility has been cleaned and the smoke detector battery has been replaced. POC corrected and cleared.

An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Staff, Victoria Azucena whose signature below confirms receipt of these rights.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1