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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601276
Report Date: 03/09/2023
Date Signed: 03/09/2023 11:49:38 AM


Document Has Been Signed on 03/09/2023 11:49 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:ANGEL'S GUEST HOME #1FACILITY NUMBER:
374601276
ADMINISTRATOR:JENKINS, PATRICIAFACILITY TYPE:
740
ADDRESS:9208 BELLAGIO RDTELEPHONE:
(619) 258-2013
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY:6CENSUS: 6DATE:
03/09/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Catherine McEvoyTIME COMPLETED:
11:55 PM
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Licensing Program Analyst (LPA) Elizabeth Hamilton made an unannounced visit to the facility to conduct a Plan of Correction (POC) visit to verify the corrections of deficiencies cited on February 7, 2023. LPA was met at the front entrance by Licensee, Catherine McEvoy, LPA identified herself, and was granted entry into facility. LPA explained the purpose of the visit.

During today's visit, LPA toured the facility and observed cited areas. A two-week extension until March 23, 2023, was provided to complete the plan of correction.

This report was discussed with Licensee, Catherine McEvoy. A copy of this report, along with Licensee/Appeal Rights, was provided.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth HamiltonTELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2023
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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