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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602987
Report Date: 03/30/2021
Date Signed: 03/30/2021 04:13:15 PM

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:GOLDEN GARDENSFACILITY NUMBER:
374602987
ADMINISTRATOR:MCKINNEY. DAVID C.FACILITY TYPE:
740
ADDRESS:725 GOLDEN LNTELEPHONE:
(760) 645-3325
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY:6CENSUS: 0DATE:
03/30/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Facility Representative, Timothy McKinney. TIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA), Eva Torres initiated a virtual visit via FaceTime to finalize the facility's closure. LPA identified herself and discussed the purpose of the visit with Facility Representative, Timothy McKinney.

On March 25, 2021, CCLD received notification that the facility has eased operation with an effective date of January 15, 2021. During the call, LPA toured of the facility, verified that there were no residents in care, as well as requested the relocation information of the residents that resided at the facility from October of 2020 through January of 2021.

A virtual exit interview was conducted with Mr. KcKinney, and the Licensee/Appeal Rights (LIC 9058 01/16) along with a copy of this report was emailed to Mr. KcKinney. A reply email or return receipt from the Mr. McKinney will confirm receipt of documents.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Evangelica TorresTELEPHONE: (619) 900-1407
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2021
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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