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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602479
Report Date: 09/07/2023
Date Signed: 09/07/2023 06:36:52 PM


Document Has Been Signed on 09/07/2023 06:36 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:
09/07/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
06:00 PM
MET WITH:Facility Administrator and Licensee Designee, Ioan Sebastian BurcaTIME COMPLETED:
06:45 PM
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Facility Administrator and Licensee Designee, Ioan Sebastian Burca.

LPA briefly toured the facility, performed a health and safety welfare check on residents in care, and spoke with staff. No deficiencies were observed or cited on this date.

An exit interview was conducted with Burca, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided.

SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2023
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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