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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604237
Report Date: 10/14/2024
Date Signed: 10/14/2024 03:51:18 PM


Document Has Been Signed on 10/14/2024 03:51 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:TENDER LOVING CARE HOME FOR ELDERLYFACILITY NUMBER:
374604237
ADMINISTRATOR:BORDON, LAURETTA MFACILITY TYPE:
740
ADDRESS:165 PALAWAN WAYTELEPHONE:
(619) 370-8008
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY:4CENSUS: 0DATE:
10/14/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Lauretta Bordon, LicenseeTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA), Carmen Lopez, conducted an unannounced visit to verify the closure of the facility. LPA Lopez identified herself and was granted entry by Lauretta Bordon, Licensee. LPA stated the purpose of the visit and verified the closure with Licensee Bordon.

During the visit, LPA Lopez toured the facility and verified that there were no elderly residents in care. All bedrooms previously occupied by residents were empty of their belongings. LPA Lopez spoke with Licensee who confirmed the there were no residents in care and the last resident who lived at the facility was during February 2023. During today’s visit Licensee Bordon, surrendered the original license.

An exit interview was conducted with Licensee Lauretta Bordon, and a copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) were provided to Licensee Bordon, at the conclusion of the visit. The signature below confirms the documents were received.
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) -34-3976
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2024
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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