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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604285
Report Date: 08/30/2022
Date Signed: 08/30/2022 02:09:00 PM

Document Has Been Signed on 08/30/2022 02:09 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:ANGELS HAVEN 3FACILITY NUMBER:
374604285
ADMINISTRATOR:FRENCH, CHRISTINEFACILITY TYPE:
735
ADDRESS:1094 MERIDIEN CTTELEPHONE:
(760) 791-3955
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY: 4CENSUS: 3DATE:
08/30/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Rowena CarlosTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced Case Management visit. LPA identified herself to and was allowed entry by Caregiver Melcor Perez, and discussed the purpose of the visit with Caregiver Rowena Carlos.

During today's visit, LPA toured the facility and observed the clients in care. LPA provided facility with personal protective equipment requested by the Administrator.

An exit interview was conducted with Rowena Carlos, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) were provided via hard copy.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/30/2022
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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