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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601276
Report Date: 03/23/2023
Date Signed: 03/23/2023 11:38:28 AM


Document Has Been Signed on 03/23/2023 11:38 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:
03/23/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Licensee, Catherine McEvoyTIME COMPLETED:
11:45 AM
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Licensing Program Analysts (LPAs) Elizabeth Hamilton and Debbie Correia 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. An extension was given until March 23, 2023. LPAs were met at the front entrance by Licensee, Catherine McEvoy, LPAs identified themselves, and were granted entry into facility. LPA Hamilton explained the purpose of the visit.

During today's visit, LPAs toured the facility and observed cited areas. Licensee cleared both side gate exits from excess items and cleared a pathway to exit out of the garage. Licensee provided verification of a new pest control company to assist with cockroach infestation with the first visit on March 23, 2023. Licensee hired a cleaning company to assist with the deep cleaning of the kitchen. LPAs did not observe any live cockroaches during the visit. POC clearance pending kitchen cleaning log.

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: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/23/2023
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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