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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603705
Report Date: 03/30/2022
Date Signed: 04/01/2022 04:57:43 PM


Document Has Been Signed on 04/01/2022 04:57 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:HEAVEN'S GRACE CARE HOMEFACILITY NUMBER:
374603705
ADMINISTRATOR:REDMAN, JONATHANFACILITY TYPE:
740
ADDRESS:113 POLK STREETTELEPHONE:
(760) 216-6706
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:6CENSUS: 0DATE:
03/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:35 PM
MET WITH:Administrator, Jonathan RedmanTIME COMPLETED:
04:00 PM
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On 3/30/2022, at 3:35 p.m., Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced closure visit to the facility. The LPA was greeted by Administrator, Jonathan Redman, identified himself and disclosed the purpose of the visit. On February 2, 2022, the Department received notification of the facility's plan to close. Consultation regarding facility closure procedures was provided to the administrator at that time.

On 3/30/2022, The LPA conducted a tour of the facility, verified the facility had no occupants, nor residents, and retrieved the facility license. Proper eviction notices and appropriate placement were verified prior to the closure visit with responsible parties and clients' current facilities.

As of today's date, the facility is considered closed. A copy of this report and Licensee rights (LIC 9058 01/16) were provided to the Administartor, Jonathan Redman, via electronic mail. An electronic mail read reciept co nfirms the documents were received by the administrator.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/30/2022
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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