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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604712
Report Date: 06/14/2024
Date Signed: 06/24/2024 02:37:58 PM


Document Has Been Signed on 06/24/2024 02:37 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: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:
06/14/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:13 PM
MET WITH:Maria Lozovyi, Licensee/AdministratorTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Daniel Pena conducted an announced closure visit to the facility. LPA was able to gain entry to the facility after ringing the doorbell. LPA spoke with Maria Lozovyi, Licensee/Administrator to confirm the facility's closure.

During the closure visit, LPA toured the facility. LPA did not observe any residents or other individuals. Before the closure visit, proper notices and relocation of residents were confirmed with responsible parties. No deficiencies were issued today, and the facility is considered closed. LPA collected the facility license.

A copy of this report and the Licensee's Appeal Rights (LIC 9058 03/22) were provided to the Licensee after the visit.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel PenaTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/12/2024
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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