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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603373
Report Date: 07/13/2022
Date Signed: 07/13/2022 01:53:43 PM

Document Has Been Signed on 07/13/2022 01:53 PM - 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:CASA ROSEFACILITY NUMBER:
374603373
ADMINISTRATOR:ROSE, MARIA ANGELESFACILITY TYPE:
735
ADDRESS:3811 BONITA GLEN TERRACETELEPHONE:
(619) 773-7692
CITY:BONITASTATE: CAZIP CODE:
91902
CAPACITY: 6CENSUS: 4DATE:
07/13/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Caregiver Maria HernandezTIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced case management visit regarding a decrease in capacity application. LPA identified herself to the Caregiver Maria Hernandez and discussed the purpose of the visit, administrator Maria Rose arrived shortly after.

A Change of Capacity application was received in the Regional Office on March 28, 2022, to decrease the capacity of the facility from six (6) to four (4). The Fire Safety Inspection Request, dated, April 11, 2022, was approved by the local fire authority on June 13, 2022.

LPA conducted a tour of the facility, and observed clients in care and there were no immediate health or safety issues noted. No deficiencies were sited on todays date.

An exit interview was conducted with the Licensee. A copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Administrator Maria Rose.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2022
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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