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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601459
Report Date: 05/21/2024
Date Signed: 05/21/2024 09:19:20 AM

Document Has Been Signed on 05/21/2024 09:19 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
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:DIONISIA HOME CARE IFACILITY NUMBER:
374601459
ADMINISTRATOR/
DIRECTOR:		VIDA DACANAYFACILITY TYPE:
735
ADDRESS:414 SHELL AVENUETELEPHONE:
(619) 292-3008
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY: 4CENSUS: 4DATE:
05/21/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:caregiver Lidia LibuanoTIME VISIT/
INSPECTION COMPLETED:
08:30 AM
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Licensing Program Analyst (LPA) Alyssa Ramirez conducted a visit to obtain signature on amended report from visit conducted on 4/18/24. LPA was welcomed by, identified herself to and was granted entry by caregiver Lidia Libuano.

During today's visit, LPA obtained caregiver Lidia Libuano's signature for LIC9099D dated 4/18/2024.

An exit interview was conducted and a copy of this report along with the Licensee's Rights (LIC9058 03/22) was provided to caregiver Lidia Libuano. Signature on this form confirms receipt of these documents.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Alyssa Ramirez
LICENSING EVALUATOR SIGNATURE: DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/21/2024
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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