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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602062
Report Date: 07/09/2021
Date Signed: 07/09/2021 05:33:48 PM

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:GOLDEN SUNSET RESIDENTIALFACILITY NUMBER:
374602062
ADMINISTRATOR:MIGUEL A MALONEFACILITY TYPE:
740
ADDRESS:7541 MILKY WAY POINTTELEPHONE:
(619) 794-2889
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY:6CENSUS: 4DATE:
07/09/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Administrator Miguel "Michael" MaloneTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Plan of Correction (POC) visit to verify that deficiencies cited on 07-01-2021 have been corrected. LPA was greeted by, identified himself, and explained the purpose of the visit to caregiver Jasmine Gonzalez-Perez. Administrator Miguel "Michael" Malone arrived during the visit. All staff encountered have a current criminal record clearance.

During today’s visit, LPA briefly toured the facility and interacted with staff and residents in care. Two (2) Type A deficiencies and one (1) Type B deficiency, which were cited on 07-01-2021, have been corrected. No new deficiencies were cited today.

An exit interview was conducted with Malone, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided via E-mail.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
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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