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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602132
Report Date: 09/14/2022
Date Signed: 09/14/2022 09:51:19 AM

Document Has Been Signed on 09/14/2022 09:51 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:ANGELES PARADISE II ARFFACILITY NUMBER:
374602132
ADMINISTRATOR:MARIA ANGIE ROSEFACILITY TYPE:
735
ADDRESS:583 MARIPOSA STTELEPHONE:
(619) 656-0062
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 5CENSUS: 4DATE:
09/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Caregiver, Noe Conteras and Licensee, Marie RoseTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an unannounced case management visit at the facility. LPA was greeted at the front entrance by Caregiver, Noe Conteras and granted entry after identifying herself. LPA met with Licensee, Maria Rose and explained the purpose of the visit, to provide regulatory guidance.

During today’s visit, LPA advised Licensee of the Incidental Medical-Program Approval that was provided to them from the Department on December 17, 2010, that indicated Indwelling Urinary Catheter/Catheter Procedures were approved medical conditions for their facility. LPA further advised Licensee to retain a copy of the restricted health condition for clients with medical conditions that fall under Title 22, Division 6, Chapter 1, Article 8 Incidental Medical Services, Section 80092 Restricted Health Conditions.

No deficiencies were cited during this visit. An exit interview was conducted with Licensee, Rose and a copy of this report and Licensee/Appeals Rights (LIC 9058 01/16) was provided.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Elizabeth Hamilton
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2022
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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