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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603843
Report Date: 04/06/2021
Date Signed: 04/06/2021 01:05:10 PM

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:HOME AWAY FROM HOME ELDERLY CAREFACILITY NUMBER:
374603843
ADMINISTRATOR:NIMER, ROSANA SFACILITY TYPE:
740
ADDRESS:11025 AVENIDA DEL GATOTELEPHONE:
(619) 846-1924
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY:6CENSUS: 0DATE:
04/06/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee, Rosana NimerTIME COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA), Natasha Persaud contacted the facility to conduct a Case Management - Other visit. The visit was conducted via Face Time due to COVID-19. LPA identified herself and discussed the purpose of the call with Licensee, Rosana Nimer.

On 04/06/21, Community Care Licensing received a letter from the licensee stating the facility is closing, due to financial hardship from the Pandemic. The letter stated there are no residents in care and they would like to close within 30 days.

During today's visit, LPA toured the facility and observed there were no residents in care and some furniture has been removed. All licensing postings have also been removed. LPA requested the original license be sent to the Regional Office. No deficiencies were issued and the facility is ready for closure.

An exit interview was conducted with Licensee, Rosana Nimer via virtual visit, and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided to the Licensee via electronic mail. An electronic read receipt confirmation was requested to be sent by the Licensee upon receipt of the documents.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2021
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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