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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601423
Report Date: 09/21/2022
Date Signed: 09/21/2022 02:26:25 PM


Document Has Been Signed on 09/21/2022 02:26 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:TANGEM GUEST HOMEFACILITY NUMBER:
374601423
ADMINISTRATOR:ALEGRE, GEMMA T.FACILITY TYPE:
740
ADDRESS:6640 PARADISE CRESTVIEW WAYTELEPHONE:
(619) 434-9073
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY:6CENSUS: 6DATE:
09/21/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Gemma T. Alegre, LicenseeTIME COMPLETED:
02:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Carmen Lopez made an unannounced visit to the facility to conduct an annual required licensing inspection and in conjunction conducted a case management visit to the facility and gave additional guidance. LPA identified herself and was granted entry by Warlita Jimenez, caregiver. LPA met with Gemma T. Alegre, Licensee, who later arrived at the facility and discussed the purpose of today’s visit.

During today’s visit, LPA toured the facility accompanied by caregiver Jimenez. LPA went over Title 22, Division 6, Chapter 8, Section 81061 Reporting Requirements, with Licensee Alegre. LPA provided Licensee Alegre guidance on Records to be Maintained at the Facility – Residential Care Facility for the Elderly (LIC 311F) and provided a copy of the LIC 311F. Based on today’s inspection no deficiencies were cited.

An exit interview was conducted with Licensee Alegre. A copy of this report, along with the Licensee Rights (03/22) was provided to Licensee Alegre at the conclusion of the visit. The signature below serves as confirmation of receipt of these documents.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:
DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/21/2022
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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