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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603005
Report Date: 03/25/2022
Date Signed: 03/25/2022 06:52:35 PM

Document Has Been Signed on 03/25/2022 06:52 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:PAULE HOME, THEFACILITY NUMBER:
374603005
ADMINISTRATOR:PAULE, PAUL MARKFACILITY TYPE:
735
ADDRESS:1878 LAGRANGE RDTELEPHONE:
(619) 941-1955
CITY:CHULA VISTASTATE: CAZIP CODE:
91913
CAPACITY: 6CENSUS: 4DATE:
03/25/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Kealoha PauleTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Rebecca Ruiz and Licensing Program Manager (LPM) Lizzette Tellez conducted an unannounced case management visit due to a request to change the facility capacity. LPA and LPM were greeted by, identified themselves to, and discussed the purpose of the visit with Licensee Kealoha Paule.

A Change of Capacity application was received by the Department on 11/16/2021, in which the licensee requested a decrease in capacity from six (6) to four (4) clients. The Fire Safety Inspection Request was approved by the local fire authority on December 16, 2021.

During today’s visit, LPA and LPM toured the facility and observed a client in care. The facility sketch was consistent with the current layout of the facility. No immediate health and/or safety concerns were observed.

The completed change of capacity request will be forwarded to management for final review and approval. An exit interview was conducted with Licensee Kealoha Paule, to whom a copy of this report and the Licensee Rights (LIC9058 01/16) were provided via email.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 03/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/25/2022
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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