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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603371
Report Date: 11/23/2020
Date Signed: 11/23/2020 01:57:00 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:MERRILL GARDENS AT OCEANSIDEFACILITY NUMBER:
374603371
ADMINISTRATOR:PEREZ, MARIANOFACILITY TYPE:
740
ADDRESS:3500 LAKE BLVDTELEPHONE:
(760) 414-9411
CITY:OCEANSIDESTATE: CAZIP CODE:
92056
CAPACITY:175CENSUS: 123DATE:
11/23/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:46 PM
MET WITH:Mariano Perez, AdministratorTIME COMPLETED:
01:57 PM
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Licensing Program Analyst (LPA) Jonathan Pineda conducted a case management tele-visit due to COVID-19 to provide Administrator, Mariano Perez an amended report for complaint received by the Department on February 5, 2020.

An exit interview was conducted via telephone and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) was provided to Administrator, Mariano Perez via email. An electronic email read receipt confirms the documents were received.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 301-9770
LICENSING EVALUATOR NAME: Jonathan C PinedaTELEPHONE: (619) 481-0846
LICENSING EVALUATOR SIGNATURE:

DATE: 11/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2020
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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