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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601239
Report Date: 10/31/2023
Date Signed: 10/31/2023 12:31:18 PM

Document Has Been Signed on 10/31/2023 12:31 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:SUNBEAM HOME CARE #2FACILITY NUMBER:
374601239
ADMINISTRATOR:DONNALYN M.PURIFICACIONFACILITY TYPE:
740
ADDRESS:4670 TWAIN AVENUETELEPHONE:
(619) 255-8326
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY: 6CENSUS: 0DATE:
10/31/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Licensee Donnalyn PurificacionTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Dang Nguyen conducted a case management visit regarding licensee-initiated facility closure. LPA was greeted by, identified himself to, and discussed the purpose of the visit with Licensee Donnalyn Purificacion.

On 10/05/2023, the licensee submitted a letter to the CCLD San Diego Regional Office stating that the facility would cease operations and close by 11/30/2023. LPA verified that all residents were successfully relocated prior to 10/25/2023.

During today's visit, LPA toured the interior and exterior of the facility and verified that there were no residents in care. All resident clothing and personal effects have been removed. All licensing postings have been taken down. The facility's original license was surrendered to LPA.

LPA advised the licensee that they are required to maintain staff and resident files for at least three years after facility closure.

No deficiencies were issued, and the facility is ready for closure.

An exit interview was conducted with Purification, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2023
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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