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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602877
Report Date: 08/05/2022
Date Signed: 08/08/2022 08:57:06 AM


Document Has Been Signed on 08/08/2022 08:57 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
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:GOLDEN CARE FACILITYFACILITY NUMBER:
374602877
ADMINISTRATOR:ERIC CASTILLOFACILITY TYPE:
740
ADDRESS:2239 CRANDALL DRIVETELEPHONE:
(858) 560-6497
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY:6CENSUS: 3DATE:
08/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Licensee, Eric CastilloTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified himself to, and explained the purpose of the visit to Licensee Eric Castillo.

LPA conducted a brief tour of the facility and observed the clients in care. In accordance with the Department’s Infection Control, LPA observed, and evaluated the facility's implementation of their COVID-19 Mitigation Plan, to include disinfection, testing surveillance, screening protocols, and the use of personal protective equipment.

No deficiencies were cited or observed on this date.

An exit interview was conducted with Licensee Eric Castillo, to whom a copy of this report and the licensee appeal rights (LIC9058 01/16) were provided via hard copy..
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 08/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/05/2022
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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