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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603033
Report Date: 03/06/2023
Date Signed: 03/06/2023 09:09:19 AM


Document Has Been Signed on 03/06/2023 09:09 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:BERLAND HOME CARE IIFACILITY NUMBER:
374603033
ADMINISTRATOR:PARAISO, DENNISFACILITY TYPE:
740
ADDRESS:508 BERLAND WAYTELEPHONE:
(619) 205-4606
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:6CENSUS: 0DATE:
03/06/2023
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Licensee Dennis Paraiso & Current Property Owner Audrey ArciagaTIME COMPLETED:
09:00 AM
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Licensing Program Analyst (LPA) Dang Nguyen conducted an announced case management visit regarding licensee initiated facility closure.

On 02-02-2023, Licensee Dennis Paraiso submitted a letter to the CCLD San Diego Regional Office stating that the facility had ceased operations and closed on 12-15-2022. LPA verified that all residents were successfully relocated prior to 12-15-2022.

Prior to today's visit, LPA spoke via phone with Paraiso and current property owner Audrey Arciaga. LPA identified himself and explained the purpose of the visit to both. Paraiso told LPA he shredded the facility's original license.

During today's visit, LPA, accompanied by Arciaga, briefly toured the facility and verified that there were no residents in care. All resident clothing and personal effects have been removed. All licensing postings have been removed. No deficiencies were issued, and the facility is ready for closure.

An exit interview was conducted with Paraiso, who joined the visit via phone. A copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided to the licensee via E-mail.

SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2023
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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