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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603354
Report Date: 08/23/2024
Date Signed: 08/23/2024 09:00:51 AM

Document Has Been Signed on 08/23/2024 09:00 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
Lookup Error,
, CA
FACILITY NAME:MAISY PLACEFACILITY NUMBER:
374603354
ADMINISTRATOR/
DIRECTOR:		MELANIE CUARESMAFACILITY TYPE:
735
ADDRESS:101 N UPAS STTELEPHONE:
(760) 738-6237
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY: 6CENSUS: 4DATE:
08/23/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Efrin Cuaresma, House ManagerTIME VISIT/
INSPECTION COMPLETED:
09:10 AM
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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced collateral visit to the facility. LPA Lopez identified herself and was granted entry by Efrin Cuaresma, House Manager. LPA stated the purpose of the visit with House Manager Cuaresma.

During the visit, LPA Lopez spoke with staff to aid in an open investigation involving a different licensed care facility. No deficiencies were observed during today's visit.

An exit interview was conducted, and a copy of this report along with Licensee/Appeal Rights (LIC9058 03/22) were provided to Efrin Cuaresma, House Manager, at the conclusion of the visit. The signature below confirms the receipt of the documents.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2024
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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