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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604712
Report Date: 03/27/2024
Date Signed: 03/28/2024 06:41:58 AM


Document Has Been Signed on 03/28/2024 06:41 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
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:PALM VIEW HOMEFACILITY NUMBER:
374604712
ADMINISTRATOR:LOZOVYI, MARIAFACILITY TYPE:
740
ADDRESS:6572 SALIZAR ST.TELEPHONE:
(858) 737-4212
CITY:SAN DIEGOSTATE: CAZIP CODE:
92111
CAPACITY:6CENSUS: 0DATE:
03/27/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Maria Lozovyi, Administrator/LicenseeTIME COMPLETED:
03:05 PM
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Licensing Program Analyst (LPA) Daniel Pena conducted a Case Management Visit to observe the physical plant. LPA was welcomed by Licensee, Maria Lozovyi to whom LPA identified himself to, and discussed the purpose of the visit.

On 03/01/2024, the Licensee submitted an LIC200 Application to the CCLD San Diego Regional Office (RO) requesting to modify the capacity of Bedroom #4 to two residents per room and convert Bedroom #2 to Office or Bedroom for Caregiver. The facility's total licensed capacity of six (6) residents will remain unchanged. The facility’s floor plan shows Bedroom #2 as Office or Caregiver and Bedroom #4 two residents.

On 03/18/2024, the local fire authority approved/granted an updated fire clearance, reflecting the facility was approved for Bedrooms 1,3,4,5,6 approved for bedridden. One bedridden resident in facility at a time.
During today’s visit, LPA briefly toured the interior and exterior of the facility. The facility sketch/floor plan was consistent with the current layout of the facility.

No deficiencies were observed or cited during today's visit.

This portion of the application process has been completed. The Licensee will be sent an updated license to reflect the new fire clearance after CCLD management’s final review and approval.

An exit interview was conducted with Ms. Lozovyi. A copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided to the Licensee during the visit.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2024
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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