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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604575
Report Date: 02/15/2024
Date Signed: 02/15/2024 11:34:43 AM

Document Has Been Signed on 02/15/2024 11:34 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:UNIVERSAL HOMES IIFACILITY NUMBER:
374604575
ADMINISTRATOR:CRISOSTOMO, YOANNEFACILITY TYPE:
735
ADDRESS:2944 SANDOVER CTTELEPHONE:
(619) 632-3549
CITY:BONITASTATE: CAZIP CODE:
91902
CAPACITY: 4CENSUS: 3DATE:
02/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Director Yoanne CrisostomoTIME COMPLETED:
11:40 AM
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Licensing Program Analyst (LPA) Juliana Barfield and Licensing Program Manager (LPM) Lizzette Tellez conducted an unannounced case management visit due to a request to change the facility ambulatory status. LPA and LPM were greeted by, identified themselves to, and discussed the purpose of the visit with Director Yoanne Crisostomo

A Change of ambulatory application was received by the Department on 12/1/2023 in which the licensee requested a change of ambulatory status from four (4) ambulatory clients to two (2) non-ambulatory clients and two (2) ambulatory clients for a total of four (4) clients. The Fire Safety Inspection Request was approved by the local fire authority on January 10, 2024.

During today’s visit, LPA and LPM toured the facility and observed no clients in care. The facility sketch was consistent with the current layout of the facility. No immediate health and/or safety concerns were observed.

The report will be forwarded to management for final review and approval. An exit interview was conducted with Director Crisostomo, to whom a copy of this report and the Licensee Rights (LIC9058 01/16) were provided at the end of the visit.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Juliana Barfield
LICENSING EVALUATOR SIGNATURE: DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/15/2024
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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