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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603373
Report Date: 05/19/2023
Date Signed: 05/19/2023 03:30:51 PM

Document Has Been Signed on 05/19/2023 03:30 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
SO. CAL AC/SC, 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: 4CENSUS: 4DATE:
05/19/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:08 PM
MET WITH:Licensee Maria RoseTIME COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Alyssa Ramirez conducted a visit to clear POC. LPA met with licensee Maria Rose.LPA checked hot water taps accessible to clients to ensure compliance. Kitchen sink was 120 F, bathroom #1 was 119 F and bathroom #2 was 119 F. An exit interview was conducted with Rose, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Alyssa Ramirez
LICENSING EVALUATOR SIGNATURE: DATE: 05/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/19/2023
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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