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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602481
Report Date: 05/06/2024
Date Signed: 05/06/2024 03:49:56 PM

Document Has Been Signed on 05/06/2024 03:49 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:COASTLINE ARF INC. PALO VERDEFACILITY NUMBER:
374602481
ADMINISTRATOR/
DIRECTOR:		LAUREANO, ALBERTOFACILITY TYPE:
735
ADDRESS:3702 PALO VERDE WAYTELEPHONE:
(760) 842-1480
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY: 4CENSUS: 4DATE:
05/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:15 PM
MET WITH:Administrator Alberto LaureanoTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Administrator Alberto Laureano.

During today's visit, LPA toured the facility and observed clients in care. Clients and staff arrived during the visit. Due to time constraints, the annual inspection could not be completed and a return visit on a subsequent day is needed.

No deficiencies were cited on today's date. An exit interview was conducted with Administrator Alberto Laureano, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 05/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/06/2024
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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