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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600785
Report Date: 12/17/2021
Date Signed: 03/03/2022 04:30:47 PM


Document Has Been Signed on 03/03/2022 04:30 PM - 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,
, CA



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:
12/17/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Administrator Leonora EnriquezTIME COMPLETED:
01:15 PM
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Licensing Program Analyst, Kayla Hilario, conducted an unannounced visit to confirm facility closure. LPA met with Administrator, Leonora Enriquez. LPA identified herself and disclosed the purpose of the visit.

LPA conducted a walk-around of the outside of the facility. In addition, LPA was allowed entry and toured the inside of the facility which determined there were no residents in care.

No deficiencies were cited or observed on this date. The Licensee was provided a copy of this report and appeal rights (LIC9058 01/16) via electronic mail.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Kayla HilarioTELEPHONE: (619) 481-0844
LICENSING EVALUATOR SIGNATURE:
DATE: 12/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/17/2021
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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