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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601178
Report Date: 11/30/2021
Date Signed: 12/01/2021 11:06:18 AM

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:HILLTOP COUNTRY ESTATEFACILITY NUMBER:
374601178
ADMINISTRATOR:RUBY RIVEREO DYFACILITY TYPE:
740
ADDRESS:28661 MEADOW GLEN WAY WESTTELEPHONE:
(760) 749-9122
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:0CENSUS: 0DATE:
11/30/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Licensee not availableTIME COMPLETED:
01:00 PM
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Licensing Program Manager (LPM) Simon Jacob and Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced closure visit to the facility. On November 10, 2021, LPA Martinez received notification of the facility closure from Licensee Ruby Dy.

LPM and LPA were greeted by Construction Worker, Patrick Telcoat, at the facility. LPM and LPA identified themselves and disclosed the purpose of the visit. Licensee Ruby Dy was not available to be present during the visit, but granted access to the facility via phone. During the closure visit, LPM and LPA observed no occupants, nor clients residing at the facility. Proper eviction notices and appropriate placement were verified prior to the closure visit with responsible parties and clients' current facilities.

As of today, the facility is considered closed. A copy of this report and Licensee rights (LIC 9058 01/16) were provided to the Licensee via email. A confirmation email has been requested.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 12/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/01/2021
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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