<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604094
Report Date: 06/14/2021
Date Signed: 06/14/2021 10:47:02 AM

Document Has Been Signed on 06/14/2021 10:47 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:LIFE SAVER PLACE OF OCEANSIDEFACILITY NUMBER:
374604094
ADMINISTRATOR:BALANQUIT, IEZL LFACILITY TYPE:
740
ADDRESS:214 MANZANITA DRTELEPHONE:
(858) 284-9114
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY: 6CENSUS: 5DATE:
06/14/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:08 AM
MET WITH:Zaldy BalanquitTIME COMPLETED:
11:24 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Kennedy conducted a case management visit regarding a change in the use of a room to be used as resident accommodations. LPA introduced herself and discussed the purpose of the visit with Zaldy Balanquit, licensee.

Prior to the visit LPA reviewed the proposed floor plan and the approved Fire Safety Inspection, conducted by Oceanside Fire Department and received by CCL on 5-11-21.

During today’s visit, LPA toured the facility, and interacted with staff and residents.

No violations were cited during today's visit. LPA recommends the approval of the use of the specified room for resident accommodations.

This report was discussed with Zaldy Balanquit, licensee.. A copy along with Licensee Rights (01/2016) was emailed to Mr. Balanquit at the conclusion of the visit. An electronic response confirms the receipt of these documents.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Anna Kennedy
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1