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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604108
Report Date: 02/13/2024
Date Signed: 02/13/2024 12:18:50 PM

Document Has Been Signed on 02/13/2024 12:18 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,
, CA
FACILITY NAME:PERPETUAL HELP HOME CAREFACILITY NUMBER:
374604108
ADMINISTRATOR:RAMIREZ, JOSE & HELENFACILITY TYPE:
740
ADDRESS:29531 MACTAN RDTELEPHONE:
(709) 913-5580
CITY:VALLEY CENTERSTATE: CAZIP CODE:
92082
CAPACITY: 6CENSUS: 6DATE:
02/13/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator Raymond RamrezTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced case management visit. The LPA introduced himself and disclosed the purpose of the visit to Administrator Raymond Ramirez.

During the visit, the LPA secured reports signatures and delivered an amended report.

An exit interview was conducted with Administrator Ramirez, to whom a copy of this report, and Licensee/Appeals Rights (LIC 9058), were provided via electronic mail. An electronic mail read receipt confirms the documents were received by Ramirez.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2024
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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