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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603760
Report Date: 03/18/2024
Date Signed: 03/18/2024 11:52:04 AM


Document Has Been Signed on 03/18/2024 11:52 AM - 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:DAYBREAK VILLA WESTFACILITY NUMBER:
374603760
ADMINISTRATOR:CORPUZ, ROLANDOFACILITY TYPE:
740
ADDRESS:1681 DAYBREAK PLACETELEPHONE:
(760) 737-6799
CITY:ESCONDIDOSTATE: CAZIP CODE:
92027
CAPACITY:6CENSUS: 0DATE:
03/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Avel Acedo, CaregiverTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to the facility to conduct a case management for concerns at the facility. LPA was informed that there are no clients in care and one (1) was relocated to a different facility. LPA conducted a walk-thru the facility and did not observe clients in care, there are no beds in the resident rooms. Two caregivers reside currently at the facility. LPA contacted Rolando Corpuz, he stated that he is no longer the administrator effective 1/1/2024 and notified San Diego CCLD. LPA contacted House Manager Odette Derafera and Licensee Zayden Chen. Licensee stated that Resident #1 (R1) wa informed of the relocation with in the required time frame. Licensee stated the facility is not closing and he is still in the process of buying the facilities from Ben Chen that began in January, 2024. Licensee stated that he is doing the operations and Odett is the current Administrator and the packet was sent to CCLD on January 24, 2024.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Yolanda DelgadoTELEPHONE: (951) 203-2990
LICENSING EVALUATOR SIGNATURE:
DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/18/2024
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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