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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603284
Report Date: 12/06/2024
Date Signed: 12/06/2024 09:32:09 AM

Document Has Been Signed on 12/06/2024 09:32 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:ARCHANGEL'S RESIDENTIAL CAREFACILITY NUMBER:
374603284
ADMINISTRATOR/
DIRECTOR:
DELA CRUZ, CHARISEFACILITY TYPE:
740
ADDRESS:7141 BULLOCK DRIVETELEPHONE:
(619) 267-7662
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY: 5TOTAL ENROLLED CHILDREN: 0CENSUS: 3DATE:
12/06/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:35 AM
MET WITH:Director Charise De La CruzTIME VISIT/
INSPECTION COMPLETED:
09:00 AM
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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Administrator Charise De La Cruz. According to the facility’s license, the facility has a maximum capacity of five (5) residents, of whom all may be non-ambulatory.

LPA toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled, as required, and stored in locked areas.



No pools or bodies of water on the premises. Per Administrator, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

Resident records contained all required documents. Personnel records reviewed contained required documentation.

No deficiencies were cited on todays date. An exit interview was conducted with Administrator, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to.

Simon JacobTELEPHONE: (619) -76-2306
Iby StrongTELEPHONE: 619-481-0846
DATE: 12/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/06/2024
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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