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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604061
Report Date: 02/27/2024
Date Signed: 02/27/2024 04:17:03 PM


Document Has Been Signed on 02/27/2024 04:17 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:CASA CIELOFACILITY NUMBER:
374604061
ADMINISTRATOR:ALLAN, BRETT KFACILITY TYPE:
740
ADDRESS:17737 HUNTERS RIDGE ROADTELEPHONE:
(619) 990-0543
CITY:SAN DIEGOSTATE: CAZIP CODE:
92127
CAPACITY:6CENSUS: 6DATE:
02/27/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Caregiver Cristina FigueroaTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced visit to conduct 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 Cristina Figueroa. Administrator Ana Hurtado arrived during the visit and assisted the LPA.

The LPA toured the facility, interviewed, and reviewed resident records. 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 the Administrator Hurtado, 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: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2024
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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