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25 | FACILITY NAME: ANGEL'S HAVEN CARE ASSISTED LIVING
TEMECULA LLC
FACILITY NUMBER: 331881572
ADMINISTRATOR:RICARDO GARCIA FACILITY TYPE: 740
ADDRESS: 32056 DAYSPRING WAY TELEPHONE: (951) 452-1216
CITY: TEMECULA STATE: CA ZIP CODE: 92591
CAPACITY: 6 CENSUS: 6 DATE: 06/11/2024
TYPE OF VISIT: Office ANNOUNCED TIME BEGAN: 03:00 PM
MET WITH: Ricardo Garcia TIME COMPLETED: 03:20 PM
NARRATIVE
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Facility Type: RCFE
Application Type: CHOW
Capacity: 6
Census (if any clients in care): 0
COMP II Participants: Ricardo Garcia, Administrator
Interview Method: Telephone interview
On 06/11/24, applicant/administrator participated in COMP II. Identification of the
applicant and administrator was verified through interview questions based on
photo ID and other identifying personal information. During COMP II, applicant
and administrator confirmed that they have read and understand community care
facility licensing laws included in the Health and Safety Codes and the California
Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been
obtained.
During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding
of following areas:
1. Facility operation: License type, client/resident populations, and program
2. Admission Policies
3. Staffing requirements & Training
4. Restrictive/Prohibited Health Conditions
5. General provisions
6. Emergency Preparedness
7. Complaints & Reporting
8. Pre-licensing readiness
SUPERVISOR'S NAME: Darla Neeley TELEPHONE: (916) 651-7817
LICENSING EVALUATOR NAME: Starla Currin TELEPHONE: (916) 651-2592
LICENSING EVALUATOR SIGNATURE:
DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/11/2024 |