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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604094
Report Date: 01/12/2024
Date Signed: 01/22/2024 05:25:26 PM

Document Has Been Signed on 01/22/2024 05:25 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: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: 3DATE:
01/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Licensee Zaldy IezlTIME COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced required Annual Inspection. The facility file was reviewed prior to the visit. LPA identified herself to caregiver Elmo DeAlba. LPA discussed the purpose of the visit with caregivers Elmo DeAlba and Jocelyn Dizon. Licensee Zaldy Iezl arrived shortly after.

During today’s visit, LPA briefly toured the facility, reviewed staff and resident records, and interviewed staff and residents. No deficiencies were cited during today’s visit. Due to time constraints, a return visit on a subsequent day is needed to complete the annual inspection.

An exit interview was conducted with Zaldy Iezl, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE: DATE: 01/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/12/2024
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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