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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601107
Report Date: 02/18/2022
Date Signed: 02/18/2022 01:28:42 PM


Document Has Been Signed on 02/18/2022 01:28 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:GALE'S GARDENFACILITY NUMBER:
374601107
ADMINISTRATOR:NICOLE MORAFACILITY TYPE:
740
ADDRESS:1127 GALE STREETTELEPHONE:
(760) 745-6844
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY:4CENSUS: 0DATE:
02/18/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Licensee Nicole MoraTIME COMPLETED:
11:30 AM
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Licensing Program Analysts (LPAs) Liliana Silveira and Iby Strong conducted a case management visit. LPAs Silveira and Strong identified themselves and explained the process of the facility closure with the Licensee Nicole Mora.

During today's visit the LPAs toured the facility and verified there are no clients in care and designated rooms are not occupied. The LPAs interviewed Licensee Nicole Mora and obtained her statement verifying the facility is voluntarily closing. The Licensee also surrendered the original copy of the license to LPA.

An exit interview was conducted with Licensee Nicole Mora and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16) was provided to her via email. An electronic receipt of confirmation was requested to be sent by the Licensee upon receipt of the documents.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 301-9770
LICENSING EVALUATOR NAME: Liliana SilveiraTELEPHONE: (619) 314-0756
LICENSING EVALUATOR SIGNATURE:
DATE: 02/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/18/2022
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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