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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604892
Report Date: 03/12/2025
Date Signed: 03/14/2025 09:18:14 AM

Document Has Been Signed on 03/14/2025 09:18 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:MELROSE 30FACILITY NUMBER:
374604892
ADMINISTRATOR/
DIRECTOR:		SONGCO, ARCELIFACILITY TYPE:
740
ADDRESS:14530 GARDEN RDTELEPHONE:
(702) 776-0689
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 6CENSUS: 0DATE:
03/12/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:41 AM
MET WITH:applicant’s representative, Justin Mendoza, Administrator. TIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Amy Rodgers conducted an announced Pre-Licensing visit to observe the facility’s physical plant for compliance with Title 22, Division 6 of the California Code of Regulations and California Health & Safety Code. LPA was greeted by, identified themselves to, and explained the purpose of the visit to the applicant’s representative, Justin Mendoza, Administrator.

During today’s visit, LPA, accompanied by the applicant’s representative, toured the interior and exterior of the facility and inspected each room. There are items which must be corrected for the facility to comply with regulations. The applicant did not pass the pre-licensing inspection, and a return visit will be required.



An exit interview was conducted with the applicant’s representative, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Amy Rodgers
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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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