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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604062
Report Date: 07/11/2023
Date Signed: 07/11/2023 10:39:37 AM


Document Has Been Signed on 07/11/2023 10:39 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:POINT LOMA ESTATES MEMORY CAREFACILITY NUMBER:
374604062
ADMINISTRATOR:SHEARER, KELLIEFACILITY TYPE:
740
ADDRESS:3423 CHANNEL WAYTELEPHONE:
(619) 224-7300
CITY:SAN DIEGOSTATE: CAZIP CODE:
92110
CAPACITY:60CENSUS: 0DATE:
07/11/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Interim Regional Director of Operations Divinia NunezTIME COMPLETED:
10:50 AM
NARRATIVE
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Licensing Program Analyst (LPA) Dang Nguyen conducted a case management visit regarding licensee-initiated facility closure. LPA identified himself to and discussed the purpose of the visit with the licensee's representative, Interim Regional Director of Operations Divinia Nunez.

On 04-22-2023, Licensee submitted a letter to the CCLD San Diego Regional Office stating that the facility would cease operations and close on 06-30-2023. LPA verified that all residents were successfully relocated prior to 06-30-2023.

During today's visit, LPA toured the interior and exterior of the facility and verified that there were no residents in care. All resident clothing and personal effects have been removed. All licensing postings have been taken down. The licensee's representative said she shredded the facility's original license.

No deficiencies were issued, and the facility is ready for closure.

An exit interview was conducted with Nunez, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/11/2023
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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