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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604580
Report Date: 11/09/2022
Date Signed: 11/09/2022 09:50:06 PM

Document Has Been Signed on 11/09/2022 09:50 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:NATURE'S RESIDENCEFACILITY NUMBER:
374604580
ADMINISTRATOR:ANDRADE, VICTOR JOSE RFACILITY TYPE:
735
ADDRESS:8554 S SLOPE DRIVETELEPHONE:
(619) 947-4870
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY: 3CENSUS: 0DATE:
11/09/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Applicant Victor AndradeTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA), Debbie Correia, conducted an announced Pre-licensing follow-up Inspection visit. LPA met with applicant Andrade, LPA Correia identified herself, was allowed entry into the facility and stated the purpose of the visit.

LPA Correia conducted a subsequent pre-licensing/ Comp III visit to ensure outstanding issues were remedied. LPA Correia observed all requirements have been met, and facility is ready for Licensure.

Based on today’s inspection, facility is recommended for Licensure. An exit interview was conducted and a copy of this report and License Rights (9058 01/16) were left with Applicant Andrade, whose signature on this form confirms receipt of these documents.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2022
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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