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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604665
Report Date: 04/03/2023
Date Signed: 04/03/2023 03:05:28 PM

Document Has Been Signed on 04/03/2023 03:05 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
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:MY BEST LIFE RESIDENTIALFACILITY NUMBER:
374604665
ADMINISTRATOR:GONZALEZ JR, EDUARDOFACILITY TYPE:
735
ADDRESS:1672 POINT REYES CTTELEPHONE:
(619) 990-8870
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 4CENSUS: 0DATE:
04/03/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Applicants Eduardo Gonzalez, Mark Black, Melinda Pontanares, and Veronica Gomez-Zavala TIME COMPLETED:
03:10 PM
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Licensing Program Analysts (LPAs) Alyssa Ramirez and Dang Nguyen conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPAs were greeted by, identified themselves to, and explained the purpose of the visit to Applicants Eduardo Gonzalez, Mark Black, Melinda Pontanares, and Veronica Gomez-Zavala.

The facility fire clearance was granted on 2/7/2023 and reflects that the facility was approved for four (4) clients in total, of which all must be ambulatory.

During today’s visit, LPAs, accompanied by the applicants toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were well lit and free of obstruction and slip hazards. Client bedrooms allowed for easy passage and contained the required furnishings. Toilets, sinks, and showers were in working order. The facility’s ambient internal temperature was 68 degrees F. Water temperature at taps accessible to clients were compliant: Bathroom #1 was 110 F, Bathroom #2 was 111 F, Bathroom #3 was 111 F, and Kitchen was 109 F.

[Continued on LIC 809-C]
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Alyssa Ramirez
LICENSING EVALUATOR SIGNATURE: DATE: 04/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/03/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: MY BEST LIFE RESIDENTIAL
FACILITY NUMBER: 374604665
VISIT DATE: 04/03/2023
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[Continued from LIC 809]

The facility has enough linens, hygiene supplies, dining supplies, and non-perishable food for future client use. Refrigerator temperature was 40 F, and freezer temperature was 0 F. The facility has sufficient space and equipment to facilitate laundry, visitation, meetings, and client activities. The facility has locked areas for storage of medication and confidential client and staff records. No pools or bodies of water were observed on the premises. There were no toxic chemicals/poisons or open-faced heaters accessible to clients. Per the applicant, no firearms or ammunition are or will be stored at the facility.

Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all operational. Two (2) fire extinguishers and two (2) first aid kits were present. Required licensing postings were observed in visible areas of the facility.

The items reviewed were complaint with Title 22, Division 6 of California Code of Regulations and Health & Safety Code. The applicant passed the pre-licensing inspection. LPAs also provided the Component III Training during today’s visit. The applicants were advised that the facility’s application is pending management final review and approval.

An exit interview was conducted with the applicants, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Alyssa Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2023
LIC809 (FAS) - (06/04)
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