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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600431
Report Date: 10/29/2024
Date Signed: 10/29/2024 04:13:10 PM

Document Has Been Signed on 10/29/2024 04:13 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:EMERALD GUEST HOMEFACILITY NUMBER:
374600431
ADMINISTRATOR/
DIRECTOR:		PETRONILA ECHEVARRIAFACILITY TYPE:
740
ADDRESS:2558 MOBLEY STREETTELEPHONE:
(858) 430-6093
CITY:SAN DIEGOSTATE: CAZIP CODE:
92123
CAPACITY: 3CENSUS: 3DATE:
10/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:55 PM
MET WITH:Licensee Petronila EcheverriaTIME VISIT/
INSPECTION COMPLETED:
04:15 PM
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Licensing Program Analysts (LPA) Juliana Barfield, David Roman, and Licensing Program Manager (LPM) Lizzette Tellez conducted an unannounced visit to do a Required Annual Inspection. LPA were welcomed by, identified themselves to, and discussed the purpose of the visit with Licensee Petronila Echeverria.

During today’s visit, LPAs briefly toured the facility, reviewed staff and client records, and interviewed residents. Due to time constraints, a return visit on a subsequent day is needed to complete the annual inspection.

No deficiencies were cited during today’s visit. An exit interview was conducted with the Licensee Petronila Echeverria, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Juliana Barfield
LICENSING EVALUATOR SIGNATURE: DATE: 10/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/29/2024
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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