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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604678
Report Date: 11/14/2024
Date Signed: 11/14/2024 11:06:04 AM

Document Has Been Signed on 11/14/2024 11:06 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:HILLTOP HOME CARE CENTER IIFACILITY NUMBER:
374604678
ADMINISTRATOR/
DIRECTOR:		JANE ARLYN H. ANTONIOFACILITY TYPE:
735
ADDRESS:3232 KEMPF STREETTELEPHONE:
(619) 777-3746
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY: 4CENSUS: 0DATE:
11/14/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:01 AM
MET WITH:Administrator Jane and Gil AntonioTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
NARRATIVE
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Licensing Program Analysts (LPAs) Amy Rodgers and Angelica Boyles conducted an unannounced case management visit to discuss the outside construction of the facility. LPAs were greeted by, identified themselves to, and discussed the purpose of the visit with Administrator/Licensee Jane Antonio and Gil.

During the annual inspection it was discovered that the outside of the facility is under construction, debris and construction material are present in the front yard and backyard. LPAs informed the Licensee that an additional inspection is needed before occupancy. Administrator agreed that they would contact CCLD prior to occupancy.

An exit interview was conducted with Administrator/Licensee Jane Antonio and Gil, to whom a copy of this report and the Licensee Rights (LIC9058 01/16) were provided at the end of the visit.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Angelica Boyles
LICENSING EVALUATOR SIGNATURE: DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/14/2024
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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