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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602479
Report Date: 07/31/2023
Date Signed: 07/31/2023 03:19:53 PM


Document Has Been Signed on 07/31/2023 03:19 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:AGAPE SENIOR CAREFACILITY NUMBER:
374602479
ADMINISTRATOR:ANGELA BURCAFACILITY TYPE:
740
ADDRESS:193 PLUMOSA STREETTELEPHONE:
(760) 207-2645
CITY:OCEANSIDESTATE: CAZIP CODE:
92058
CAPACITY:6CENSUS: 2DATE:
07/31/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Administrator, Ioan Sebastian BurcaTIME COMPLETED:
03:20 PM
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Licensing Program Manager (LPM) Lizzette Tellez, conducted an Office Meeting with the Facility Administrator and Licensee Designee, Ioan Sebastian Burca, to review pending application items.

During today's meeting, LPM Tellez and Mr. Burca discussed pending application items. The Change of Ownership process and Health and Safety Code 1569.193 were discussed. The following items are pending to CCL:
  1. A completed LIC 200 - Application by August 7, 2023.
  2. Proof of Control of Property: New Rental/Lease Agreement
  3. A copy of the Death Certificate, once received.

Once the above items are submitted, an Emergency Approval to Operate will be issued to the designee. The Department will decide within 60 days whether to issue a provisional license. An exit interview was conducted with Mr. Burca. A copy of this report, HSC 1569.193, along with Licensee/Appeal Rights, were provided to Mr. Burca at the conclusion of the meeting.
SUPERVISOR'S NAME: Icela EstradaTELEPHONE: (619) 688-6866
LICENSING EVALUATOR NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR SIGNATURE:
DATE: 07/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2023
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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