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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602552
Report Date: 08/18/2023
Date Signed: 08/18/2023 04:09:14 PM

Document Has Been Signed on 08/18/2023 04:09 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:ANGELS HAVEN IIFACILITY NUMBER:
374602552
ADMINISTRATOR:FRENCH, CHRISTINEFACILITY TYPE:
735
ADDRESS:3949 BAJA VISTA DRIVETELEPHONE:
(760) 722-3955
CITY:OCEANSIDESTATE: CAZIP CODE:
92054
CAPACITY: 6CENSUS: 4DATE:
08/18/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:26 AM
MET WITH:Art Lopez, LicenseeTIME COMPLETED:
03:01 PM
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Licensing Program Analyst (LPA) Esther Miller conducted an unannounced case management visit. LPA was greeted and allowed entry by Marisol "Mayra" Callado, House Manager, to whom the purpose of the visit was disclosed to. Licensee Christine French and Licensee Art Lopez arrived during the visit.

During today's visit, LPA briefly toured the facility, interviewed staff, and requested records. On August 16, 2023, Community Care Licensing received a death report regarding Client 1 (C1). The report stated that C1 passed away on August 15, 2023 after a medical emergency. Staff 1 (S1) and Staff 2 (S2) were unavailable for interviews.

No deficiencies were issued today and no health or safety issues were identified. An exit interview was conducted with Art Lopez, Licensee, and a copy of this report, along with Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE: DATE: 08/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/18/2023
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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