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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603744
Report Date: 05/10/2024
Date Signed: 05/10/2024 03:17:47 PM


Document Has Been Signed on 05/10/2024 03:17 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:SKYVIEW GARDENSFACILITY NUMBER:
374603744
ADMINISTRATOR:WERY, TERRY ANNFACILITY TYPE:
740
ADDRESS:14215 MIDLAND ROADTELEPHONE:
(858) 335-0916
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:15CENSUS: 11DATE:
05/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Manager Everett Wery and Caregiver Elna GoetzTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced visit to initiate a Required Annual Inspection. The facility file was reviewed prior to the visit. The LPA introduced himself and disclosed the purpose of the visit to Caregiver Elna Goetz. Manager Everett Wery arrived during the visit and assisted the LPA.

During the inspection the LPA, accompanied by staff, toured the interior and exterior of the facility, and inspected resident bedrooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities.



There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. No pools, nor bodies of water bodies of water were observed on the premises. Per staff, no firearms or ammunition were kept at the facility.

No deficiencies were cited during today’s visit. Due to time constraints, a return visit on a subsequent day is needed to complete the annual inspection.

An exit interview was conducted with Manager Everett Wery, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058), were provided.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2024
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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