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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603284
Report Date: 12/10/2021
Date Signed: 12/10/2021 05:29:13 PM

Document Has Been Signed on 12/10/2021 05:29 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:ARCHANGEL'S RESIDENTIAL CAREFACILITY NUMBER:
374603284
ADMINISTRATOR:CHARISE CANDAREFACILITY TYPE:
740
ADDRESS:7141 BULLOCK DRIVETELEPHONE:
(619) 267-7662
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY: 5CENSUS: 3DATE:
12/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Charise Candare, LicenseeTIME COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Dawn Segura visited the facility to conduct an annual required licensing inspection. LPA was granted entry into the facility by Arian Ysais, Staff, to whom she disclosed the purpose of the visit. A short time later, licensee, Charise Candare, arrived at the facility.

During today's visit, LPA toured the facility's and verified compliance with infection control practices. LPA and Charise Candare reviewed the facility's Plan for Epidemic Outbreak Specific to COVID-19. LPA observed one central entry point for hand sanitizing; routine symptom screening was previously initiated at entry for staff, residents, and visitors and will be re-started; a sign-in policy enacted for visitors; signs in the facility to promote hand hygiene, symptom and transmission awareness; face coverings worn by staff; hand sanitizer/hand washing stations readily available; available visitation areas; emergency agencies’ contact information visible to staff; and an ample supply of cleaning products and PPE.

No deficiencies were cited during today’s visit. An exit interview was conducted with Charise Candare, Licensee, and a copy of this report and Licensee Rights (LIC 9058 FAS 01/16) will be provided, via email, following the visit. An electronic receipt of confirmation was requested to be sent to LPA upon receipt of the documents.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2021
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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