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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600785
Report Date: 05/26/2021
Date Signed: 05/26/2021 01:39:59 PM

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:GOLDEN YEARS HOME CAREFACILITY NUMBER:
374600785
ADMINISTRATOR:LEONORA A. ENRIQUEZFACILITY TYPE:
740
ADDRESS:2612 LAS PALMAS AVENUETELEPHONE:
(760) 839-2186
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:6CENSUS: 0DATE:
05/26/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Licensee, Leonora Enriquez TIME COMPLETED:
09:00 AM
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Licensing Program Analyst (LPA) Eva Torres conducted an unannounced case management visit to document the closure of the facility, which was initiated by the Licensee, Leonora Enriquez. LPA identified herself and discussed the purpose of the visit with Mrs. Enriquez.

During today’s visit, LPA learned that the licensee eased operation with an effective date of May 15, 2021. LPA briefly toured the facility and observed no residents in care. Mrs. Enriquez informed the LPA that they forwarded their license to CCLD.

An exit interview was conducted with Mrs. Enriquez, and the Licensee's Rights (LIC 9058 01/16) and a copy of this report was emailed to them. Mrs. Enriquez's signature on this form confirms receipt of documents.

SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Evangelica TorresTELEPHONE: (619) 900-1407
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2021
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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