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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601423
Report Date: 04/13/2021
Date Signed: 04/13/2021 11:22:35 AM

Document Has Been Signed on 04/13/2021 11:22 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:TANGEM GUEST HOMEFACILITY NUMBER:
374601423
ADMINISTRATOR:ALEGRE, GEMMA T.FACILITY TYPE:
740
ADDRESS:6640 PARADISE CRESTVIEW WAYTELEPHONE:
(619) 434-9073
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY: 6CENSUS: 5DATE:
04/13/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator, Gemma AlegreTIME COMPLETED:
11:19 AM
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Licensing Program Analyst (LPA) Lizzette Tellez, conducted a case management visit, via telephone due to COVID-19, to provide technical assistance and review the facility's COVID-19 mitigation plan. LPA identified herself to Administrator, Gemma Alegre, and discussed the purpose of the visit.

During today's visit, LPA toured the facility, and interviewed the Administrator.

No deficiencies were issued during this visit. An exit interview was conducted. A copy of this report and Licensee's Rights (9058 01/16) were provided to the Administrator via electronic mail. An email receipt confirms the acknowledgement of these documents.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Lizzette Tellez
LICENSING EVALUATOR SIGNATURE: DATE: 04/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/13/2021
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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