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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604117
Report Date: 02/16/2023
Date Signed: 02/16/2023 10:43:49 AM

Document Has Been Signed on 02/16/2023 10:43 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:ROSE'S CANYON VIEW ESTATEFACILITY NUMBER:
374604117
ADMINISTRATOR:PARAISO, CATHERINE TFACILITY TYPE:
740
ADDRESS:2644 CANYON RDTELEPHONE:
(760) 739-0311
CITY:ESCONDIDOSTATE: CAZIP CODE:
92025
CAPACITY: 6CENSUS: 5DATE:
02/16/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Julianna Castro, CaregiverTIME COMPLETED:
10:45 AM
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Licensing Program Analyst(LPA) Tricia Danielson arrived to the facility unannounced to conduct a collateral visit as a result of a complaint investigation being conducted at another licensed facility and completely unrelated to this facility. LPA met with Caregiver Julianna Castro and explained the nature of today's visit.

During today's visit, LPA interviewed Resident #1(R1).

An exit interview was conducted and a copy of this report was provided along with LIC811- Confidential Names list.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023
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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