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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604410
Report Date: 05/24/2022
Date Signed: 07/18/2022 10:13:11 AM


Document Has Been Signed on 07/18/2022 10:13 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:MARY CATHERINE'S HOMEFACILITY NUMBER:
374604410
ADMINISTRATOR:BHAGAT, SUDARSHANFACILITY TYPE:
740
ADDRESS:1540 DARLING DRTELEPHONE:
(424) 344-8265
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:6CENSUS: 0DATE:
05/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:TenentTIME COMPLETED:
09:45 AM
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LPA arrived to the address to conduct an annual evaluation. LPA rang the doorbell and knocked on the door. A young Hispanic male answered the door and LPA identified herself and explained the reason for her arrival. The male, who declined to provide his name, stated that the home was no longer being utilized as a facility for elderly people and that they have had at least two (2) other licensing visits since they moved in. The male reported he, his dad, uncle, and cousin have been renting the home for the last approximately eight (8) months. The male allowed LPA to enter the home and verify that no residents were in care. LPA observed the home to be fully furnished with some licensing posters still hung on the wall and resident recliners huddled in the back of the front living room. The male stated they rented the home furnished with the exception of the bedrooms. LPA observed some bedrooms to be empty while four (4) rooms were being utilized by the male, his dad, uncle, and cousin. The male stated the owner of the home is a doctor who used to run the facility. The male thought that the facility was out of operation for at least a year.
LPA thanked the male for his time and exited the home. LPA also observed the remnants of previously posted COVID posters on the front door.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:
DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/24/2022
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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