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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600996
Report Date: 03/05/2025
Date Signed: 03/05/2025 04:35:15 PM

Document Has Been Signed on 03/05/2025 04:35 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:VELASCO HOMES #5, THEFACILITY NUMBER:
374600996
ADMINISTRATOR/
DIRECTOR:		SANFORD, LAILANI JOYFACILITY TYPE:
740
ADDRESS:1564 MALTA AVENUETELEPHONE:
(619) 476-7011
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 6CENSUS: 3DATE:
03/05/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:DSP Flavel CatahanTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with DSP Flavel Catahan.

Today's visit was in response to Licensee’s self-reported death of Resident #1 (R1), received at the CCLD San Diego Regional Office on 02/19/2025. [See LIC 811 Confidential Names List for a description of R1]. Per the report, C1 passed away on 02/18/2025.

During today’s visit, LPA performed a brief facility tour and welfare check on remaining three (3) residents, finding no safety concerns. LPA also collected copies of and reviewed pertinent records and interviewed relevant staff.

No deficiencies were observed or cited during today’s visit.

An exit interview was conducted with Catahan. A copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided to Licensee during the visit.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/05/2025
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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