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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604304
Report Date: 04/10/2024
Date Signed: 04/10/2024 10:10:57 AM


Document Has Been Signed on 04/10/2024 10:10 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:BLUE SKIES OF OCEANSIDEFACILITY NUMBER:
374604304
ADMINISTRATOR:GAMAB, RAFAELFACILITY TYPE:
740
ADDRESS:322 KEYPORT ST.TELEPHONE:
(619) 208-7869
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY:6CENSUS: 4DATE:
04/10/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
09:46 AM
MET WITH:Caregiver Jemela MagulodTIME COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced collateral visit to conduct a resident interview. The LPA introduced himself to Caregiver Jemela Magulod, and disclosed to the purpose of the visit.

Review of records and an interview with Magulod revealed Resident # 1 (R1) did not reside at the facility.

An exit interview was conducted with Caregiver Magulod, to whom a copy of this report, and Licensee/Appeal Rights, were provided.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 04/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/10/2024
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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