<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604064
Report Date: 09/22/2023
Date Signed: 09/22/2023 11:14:04 AM

Document Has Been Signed on 09/22/2023 11:14 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
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:GANDARA RESIDENTIAL CARE 2FACILITY NUMBER:
374604064
ADMINISTRATOR:GANDARA, JACQUELINEFACILITY TYPE:
735
ADDRESS:1522 HAWKEN DRIVETELEPHONE:
(619) 661-6817
CITY:SAN DIEGOSTATE: CAZIP CODE:
92154
CAPACITY: 4CENSUS: 3DATE:
09/22/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Staff Reyva CovianTIME COMPLETED:
11:45 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Alyssa Ramirez conducted a visit to clear POC. LPA met with staff Reyna Covian. LPA checked hot water taps accessible to clients to ensure compliance. Kitchen sink was 107 F (in compliance).An exit interview was conducted with staff, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Alyssa Ramirez
LICENSING EVALUATOR SIGNATURE: DATE: 09/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1