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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604738
Report Date: 04/10/2024
Date Signed: 04/10/2024 10:08:09 AM

Document Has Been Signed on 04/10/2024 10:08 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/
DIRECTOR:		GAMAB, LAURICEFACILITY TYPE:
740
ADDRESS:4676 MARBLEHEAD BAY DR.TELEPHONE:
(619) 208-7869
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY: 6CENSUS: 4DATE:
04/10/2024
TYPE OF VISIT:CollateralUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:46 AM
MET WITH:Caregiver Jemela MagulodTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced collateral visit to conduct a resident interview. The LPA introduced himself to Caregiver Jemela Magulod, and disclosed to the purpose of the visit.

Review of records and an interview with Magulod revealed Resident # 1 (R1) did not reside at the facility.

An exit interview was conducted with Caregiver Magulod, to whom a copy of this report, and Licensee/Appeal Rights, were provided.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 04/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/10/2024
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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