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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604665
Report Date: 01/19/2024
Date Signed: 01/19/2024 10:55:31 AM

Document Has Been Signed on 01/19/2024 10:55 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: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: 3DATE:
01/19/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
09:29 AM
MET WITH:Veronica ZavalaTIME COMPLETED:
11:03 AM
NARRATIVE
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Licensing Program Analyst (LPA), Ramon Serrano, conducted an unannounced collateral visit as a follow-up for an unrelated complaint investigation for another facility. LPA was allowed entry by Administrator Veronica Zavala and discussed the purpose of the visit.

During the visit, LPA conducted an interview and obtained facility records.

An exit interview was conducted with Veronica Zavala and copy of this report along with Licensee Rights (LIC 9058 3/22) was provided to Veronica Zavala whose signature below verifies receipt of these rights.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2024
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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