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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604738
Report Date: 03/27/2024
Date Signed: 03/27/2024 09:55:41 AM

Document Has Been Signed on 03/27/2024 09:55 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:BLUE SKIES OF THE VALLEYFACILITY NUMBER:
374604738
ADMINISTRATOR:GAMAB, LAURICEFACILITY TYPE:
740
ADDRESS:4676 MARBLEHEAD BAY DR.TELEPHONE:
(619) 208-7869
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY: 6CENSUS: 0DATE:
03/27/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:House Manager Lauren DeLanceyTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced case management visit due to a request to change the facility capacity. LPA was greeted by, identified herself to, and discussed the purpose of the visit with House Manager Lauren DeLancey.

A Change of Capacity application was received by the Department on February 2, 2024, in which the licensee requested an increase in non-ambulatory capacity from 0 to 2 residents. The Fire Safety Inspection Request was approved by the local fire authority on March 11, 2024 with the requirement that the 2 non-ambulatory residents will reside in the room noted Bedroom #5 on the facility sketch.

During today’s visit, LPA toured the facility and inspected each room. No residents were admitted to the facility at the time of LPA's inspection. The facility sketch was consistent with the current layout of the facility. No immediate health and/or safety concerns were observed during today's visit.

The completed change of capacity request will be forwarded to management for final review and approval. An exit interview was conducted with House Manager Lauren DeLancey, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/27/2024
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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