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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603049
Report Date: 06/10/2024
Date Signed: 06/10/2024 10:09:45 AM


Document Has Been Signed on 06/10/2024 10:09 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:UTOPIA HOMEFACILITY NUMBER:
374603049
ADMINISTRATOR:HAVERLY, HANNAHFACILITY TYPE:
735
ADDRESS:11285 PEGASUS AVETELEPHONE:
(858) 564-8190
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY:6CENSUS: 0DATE:
06/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Hannah Haverly, AdministratorTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Hall conducted an announced closure visit to the facility. LPA was able to gain entry to the facility after ringing the doorbell. LPA spoke with Administrator  Hannah Haverly to confirm the facility's closure due to a change of location.

During the closure visit, LPA observed the facility. LPA did not observe any residents or other individuals. Before the closure visit, proper notices and relocation of residents were confirmed with responsible parties. No deficiencies were issued today, and the facility is considered closed. LPA collected the facility license.

A copy of this report and the Licensee's Appeal Rights (LIC 9058 03/22) were provided to the Licensee after the visit.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Renita HallTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/10/2024
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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