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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603083
Report Date: 01/17/2023
Date Signed: 01/17/2023 11:14:28 AM

Document Has Been Signed on 01/17/2023 11:14 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:ANGELS IN GRACEFACILITY NUMBER:
374603083
ADMINISTRATOR:CASTRO, MARIA EUGENIAFACILITY TYPE:
740
ADDRESS:349 VIA METATETELEPHONE:
(760) 724-2354
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY: 6CENSUS: 5DATE:
01/17/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee, Maria CastroTIME COMPLETED:
11:00 AM
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Interim Assistant Program Administrator (IAPA) Icela Estrada, Interim Regional Manager (IRM) Simon Jacob, and Licensing Program Manager (LPM) Lizzette Tellez conducted an Office Meeting with Licensee, Maria Castro, and their relative, Jessie Castro, to discuss the facility's fire clearance and pending application items.

On 1/13/23, the RO was notified that the facility's request for a fire clearance for bedridden residents was denied by the Oceanside Fire Department. During today's meeting, Ms. Castro provided information regarding the status of the current residents, along with a plan for needed changes to the facility's structure. Ms. Castro stated she would inform the RO when these changes are completed. The RO will reach out to Oceanside Fire Department requesting a Fire Safety Inspection. On today's date, the Licensee submitted a revised LIC 200 - Application requesting a change of ambulatory status.

An exit interview was conducted with Ms. Castro. A copy of this report was provided to her at the conclusion of the meeting.
SUPERVISORS NAME: Icela Estrada
LICENSING EVALUATOR NAME: Lizzette Tellez
LICENSING EVALUATOR SIGNATURE: DATE: 01/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/17/2023
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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