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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603018
Report Date: 08/24/2021
Date Signed: 08/25/2021 06:52:17 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:3 SISTERS HACIENDA, LLCFACILITY NUMBER:
374603018
ADMINISTRATOR:AMUNDSON, TAMARAFACILITY TYPE:
740
ADDRESS:1911 BEAR VALLEY OAKSTELEPHONE:
(760) 294-7996
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY:6CENSUS: 0DATE:
08/24/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
09:15 PM
MET WITH:Malchow, Laura- AdministratorTIME COMPLETED:
09:50 PM
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Licensing Program Analyst (LPA) Liliana Silveira conducted a case management visit. LPA Silveira identified herself and explained the process of the facility closure with the Administrator Laura Malchow.

During today's visit, LPA Silveira toured the facility and verified there are no clients in care and designated rooms are not occupied. LPA Silveira interviewed Administrator Laura Malchow and obtained her statement verifying the facility is voluntarily closing.

An exit interview was conducted with Administrator Laura Melchow and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16) was provided to her via email. An electronic receipt of confirmation was requested to be sent by the Administrator upon receipt of the documents.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 301-9770
LICENSING EVALUATOR NAME: Liliana SilveiraTELEPHONE: (619) 314-0756
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2021
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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