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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600888
Report Date: 02/07/2023
Date Signed: 02/07/2023 11:22:01 AM

Document Has Been Signed on 02/07/2023 11:22 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:MICHAEL'S RESIDENTIAL CENTER-2FACILITY NUMBER:
374600888
ADMINISTRATOR:FLOR DE LYS BARAWIDFACILITY TYPE:
735
ADDRESS:1292 CONWAY DRIVETELEPHONE:
(760) 743-3681
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY: 6CENSUS: 6DATE:
02/07/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Romeo LabastidaTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to the facility to conduct a case management to check on the health, safety, and welfare of residents in care. LPA met with Caregivers Higinio (Gino) and Elicia Alvarez, Caregivers and explained the purpose of the visit. Administrator Romeo Labastida arrived during the visit.

Four (4) of six (6) residents in care; one (1) resident hospitalized and one (1) resident at program. No imminent health and/or safety concerns were observed at the time of visit. LPA observed no health and/or safety hazards inside the facility. LPA observed all facility utilities to be on and operating without issue. There was a sufficient amount of staff present at the facility to provide care. LPA assessed the available food supply and observed that the supply exceeds the requirement of a two (2) day supply of perishable foods and a seven (7) day supply of non-perishable foods. Medications were found to be in sufficient supply as well.
Based on the information obtained during today's visit, there are no immediate threats to the health, safety, and welfare of the residents in care. No deficiencies were cited during today's visit.

An exit interview was conducted and a copy of this report was provided to Romeo Labastida.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE: DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/07/2023
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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