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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604148
Report Date: 02/14/2024
Date Signed: 02/14/2024 11:33:30 AM

Document Has Been Signed on 02/14/2024 11:33 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:ABIGAIL'S HOMES IIFACILITY NUMBER:
374604148
ADMINISTRATOR:GONZALEZ, BRENDA ABIGAILFACILITY TYPE:
735
ADDRESS:8738 VALENCIA STTELEPHONE:
(619) 315-7407
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY: 4CENSUS: 3DATE:
02/14/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Caregiver Omar CoronaTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced Plan of Correction (POC) visit. LPA was greeted by, identified herself to, and explained the purpose of the visit to Caregiver Omar Corona. LPA spoke Administrator Brenda Gonzalez via telephone.

The purpose of the visit was to verify if the deficiency issued on 1/9/2024 had been corrected. On 1/9/2024, the licensee was issued a deficiency for regulation 80068.3(a) with a correction due date of 2/6/2024. On 2/8/2024, Administrator requested an extension for POC due date. On 2/14/2024, the Administrator submitted proof of correction to the Department. Therefore, this deficiency is cleared.

During today’s visit, LPA Ruiz spoke with Administrator Brenda Gonzalez to confirm reason for POC due date extension. LPA approved a POC due date extension with the new due date being 2/16/2024 on an LIC178. LPA provided technical assistance and consultation regarding requesting POC extensions on an LIC9102TA.

An exit interview was conducted with Administrator Brenda Gonzalez via telephone and Caregiver Omar Corona, whose signature below confirms receipt of a copy of this report, the LIC178, the LIC9102TA, the letter of Deficiency Citations Cleared, and the Licensee Appeal Rights (LIC9058 01/16).
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2024
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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