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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604764
Report Date: 03/14/2024
Date Signed: 03/14/2024 06:38:10 PM

Document Has Been Signed on 03/14/2024 06:38 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:GRACEFUL CARE HOMES #1FACILITY NUMBER:
374604764
ADMINISTRATOR:RAMI BRIKHOFACILITY TYPE:
735
ADDRESS:10404 LEN COURTTELEPHONE:
(619) 971-1230
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY: 6CENSUS: 0DATE:
03/14/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Applicant Rami BrikhoTIME COMPLETED:
03:50 PM
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Licensing Program Analyst (LPA) Debbie Correia conducted a Pre-licensing visit to observe the physical plant for compliance per Title 22, Division 6 of the CA Code of Regulations and Health & Safety codes. LPA Correia was met by Applicant Bikroh, identified herself, and was granted entry into the facility.

LPA Correia, accompanied by Applicant Bikroh, conducted an internal and external tour of the facility. Due to a few outstanding items being addressed by the Applicant, LPA will return at a later date to reinspect the property for licensure recommendation

An exit interview was conducted with Applicant Bikroh, and a copy of this report and Licensee Appeal Rights (LIC 9058) will be provided for facility records.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2024
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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