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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603038
Report Date: 11/30/2023
Date Signed: 11/30/2023 11:15:00 AM

Document Has Been Signed on 11/30/2023 11:15 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:ACOSTA ARF #4FACILITY NUMBER:
374603038
ADMINISTRATOR:BERNADETTE ACOSTAFACILITY TYPE:
735
ADDRESS:6265 CHILDS AVENUETELEPHONE:
(619) 399-5994
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY: 6CENSUS: 4DATE:
11/30/2023
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Brianna Cartier, DesigneeTIME COMPLETED:
10:45 AM
NARRATIVE
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Assistant Program Administrator (APA) Icela Estrada and Licensing Program Managers (LPMs) Denise Powell and Simon Jacob conducted an Office Meeting with the late Licensee's Designee, Brianna Cartier and Administrator, Nicolle Duque to discuss the succession plan, Emergency Approval to Operate process, and pending application items.

During today's meeting, the requirements of the Health and Safety Code 1524 and CCR, Title 22, Section 80035 were discussed. Designee, Brianna Cartier provided evidence of Licensee Bernadette Acosta death which occurred on November 22, 2023. Designee and granddaughter of late licensee, confirmed that on November 24, 2023, she notified the Department by email of the licensee's death and expressed her intention to operate the community care facilities. On November 24, 2023, Ms. Cartier filed an Application for License (LIC 200 7/91) with the Department via email, which was within five days of the licensee's death. The Regional Office forwarded the LIC 200 to the Department's Centralized Application Bureau on November 28, 2023. Today, additional application packets were provided to Ms. Cartier as she had listed all three facilities in one LIC 200. Per Health and Safety Code (HSC) 1524, the Department is permitting Ms. Cartier to submit only the information on the front side of the LIC 200s. During the meeting Ms. Cartier completed the applications and submitted them.

HSC 1524 requires that the relative files with the CA Department of Justice within five calendar days of the licensee's death his/her fingerprint cards. During the meeting, we learned that this was not communicated to her during the time she contacted the Regional Office. Designee agrees to file her fingerprint card today and will send verification to the Regional Office email by close of business.

Once the fingerprint card is submitted, Emergency Approval to Operate will be issued to the designee. The Department will decide within 60 days whether to issue a provisional license. An exit interview was conducted and a copy of this report was provided to Administrator, Nicolle Duque and Ms. Cartier.
SUPERVISORS NAME: Icela Estrada
LICENSING EVALUATOR NAME: Denise Powell
LICENSING EVALUATOR SIGNATURE: DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/30/2023
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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