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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604824
Report Date: 01/29/2025
Date Signed: 01/29/2025 03:33:56 PM

Document Has Been Signed on 01/29/2025 03:33 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:MT. HELIX RESIDENTIAL CARE INCFACILITY NUMBER:
374604824
ADMINISTRATOR/
DIRECTOR:		BARWARI, HALATFACILITY TYPE:
740
ADDRESS:10895 CHALLENGE BLVDTELEPHONE:
(619) 277-7067
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY: 6CENSUS: 0DATE:
01/29/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Kamal Barwari, LicenseeTIME VISIT/
INSPECTION COMPLETED:
03:40 PM
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Licensing Program Analyst (LPA) Renita Hall conducted an announced pre-licensing visit. LPA was allowed entry by Kamal Barwari, Licensee.  LPA identified herself and disclosed the purpose of the visit.

This report documents the pre-licensing Component III visit conducted to determine the applicant's readiness to operate a Residential Care Facility for the Elderly in compliance with Title 22 regulations and the facility’s established operational plan.  Additional requirements have been identified, please prepare evidence of completed corrections and any necessary documentation for review during the next evaluation visit.

An exit interview was conducted with the Licensee, to whom a copy of this report, and the Applicant/Appeal Rights (LIC9058), were provided.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2025
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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