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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604620
Report Date: 12/02/2022
Date Signed: 12/02/2022 12:03:59 PM

Document Has Been Signed on 12/02/2022 12:03 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:LAKE CANYON HOME CAREFACILITY NUMBER:
374604620
ADMINISTRATOR:RODRIGUEZ, OLIVER CUEVASFACILITY TYPE:
735
ADDRESS:9460 LAKE CANYON RDTELEPHONE:
(619) 800-2036
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY: 4CENSUS: 0DATE:
12/02/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Administrator Oliver CuevasTIME COMPLETED:
12:05 PM
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Licensing Program Analysts (LPAs) Tammer De Los Santos and Kayla Hilario conducted an announced Pre-Licensing inspection. LPAs identified themselves, discussed the purpose of the visit, and met with Administrator Oliver Cuevas.

LPAs conducted a tour of the facility, both inside and outside. There are no pools on site. The smoke and carbon monoxide alarms were present. Toilets intended for client use were operating as intended, and bathing facilities were observed to be clean and kempt. The windows, blinds and paint throughout the facility, was observed in good condition. Each room intended for client use had appropriate appropriate lighting. Furniture to be moved from current facility to this new facility. Administrator Cuevas stated there are no firearms stored on the premises.

Hot water temperature was measured in the facility at 117.0 degrees F. The ambient temperature inside the facility was measured with at 68 degrees F. The facility was observed to be clean and kempt with no strong malodors. The refrigerators and freezers were observed to be clean and operational, with an ample amount of food to meet client needs. Cleaning solutions were also properly secured.

The Component III portion of the application process was completed with Cuevas on today's date.

Pre-Licensing is complete and this facility has no deficiencies. An exit interview was conducted with Administrator Oliver Cuevas. The Applicant was provided with a copy of this report and Appeal/Licensee rights (LIC9058 03/2022) via hardcopy at the conclusion of the visit.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Kayla Hilario
LICENSING EVALUATOR SIGNATURE: DATE: 12/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/02/2022
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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