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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603273
Report Date: 02/21/2025
Date Signed: 02/21/2025 02:21:19 PM

Document Has Been Signed on 02/21/2025 02:21 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:MYLDA SENIOR CARE FACILITYFACILITY NUMBER:
374603273
ADMINISTRATOR/
DIRECTOR:		MIRIAM MEHZUN HADGUFACILITY TYPE:
740
ADDRESS:3535 FENELON STREETTELEPHONE:
(619) 223-3700
CITY:SAN DIEGOSTATE: CAZIP CODE:
92106
CAPACITY: 6CENSUS: 2DATE:
02/21/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Licensee Miriam Mehzun HadguTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Juliana Barfield conducted a Case Management visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Licensee Miriam Mehzun Hadgu.

During the visit, LPA collected an Application for a Community Care Facility or Residential Care Facility for the Elderly License, (LIC200) and an updated facility sketch for a change of ambulatory status at the facility.

No deficiencies were observed or cited on this date.

An exit interview was conducted with Miriam Mehzun Hadgu, to whom a copy of this report was provided during the visit.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Juliana Barfield
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2025
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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