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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604282
Report Date: 04/27/2022
Date Signed: 04/27/2022 04:15:07 PM

Document Has Been Signed on 04/27/2022 04:15 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:ABIGAIL'S HOMES IIIFACILITY NUMBER:
374604282
ADMINISTRATOR:GONZALEZ, BRENDA ABIGAILFACILITY TYPE:
735
ADDRESS:2505 ARCADIA AVETELEPHONE:
(619) 439-7791
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY: 4CENSUS: 2DATE:
04/27/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Raquel GarciaTIME COMPLETED:
04:18 PM
NARRATIVE
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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to deliver amended findings. LPA identified herself, was granted entry, and stated the purpose of the visit to Raquel Garcia, Administrator.

LPA went over amended 9099d page and explained to Administrator that they have already completed all of the necessary Plan of Correction (POCs).

An exit interview was conducted with Raquel Garcia. A copy of this report and Licensee Appeal Rights (9058 01/16) were provided to Administrator after the conclusion of the visit,
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 04/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/27/2022
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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