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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 364840450
Report Date: 08/14/2019
Date Signed: 08/14/2019 04:11:03 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:CASA RAMONA INCFACILITY NUMBER:
364840450
ADMINISTRATOR:TABITHA THURFACILITY TYPE:
850
ADDRESS:1633 W. 5TH STREETTELEPHONE:
(909) 889-0011
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92411
CAPACITY:45CENSUS: 19DATE:
08/14/2019
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:56 PM
MET WITH:Tabitha ThurTIME COMPLETED:
04:16 PM
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While conducting another visit, the LPA Floria informed the Executive Director regarding the annual fees showing in the Licensing Information was unpaid and one of the referenced adult employee's fingerprint clearance was still pending.

The Executive Director Esther Estrada provided the LPA receipts and copy the check that showed as proof of payment. The LPA will provided this receipt to the Department to properly reconcile and record the payment.

The Center Director Tabitha Thur noted the referenced individual noted on the Licensing Information System was not hired and has not worked at this facility due to of the fingerprint has not cleared.

During this visit, no deficiency was noted.

An exit interview was conducted, a copy of this report was provided.
This report shall be made available to the public for three (3) years.
SUPERVISOR'S NAME: Aaron RossTELEPHONE: (951) 320-2023
LICENSING EVALUATOR NAME: Fe FloriaTELEPHONE: (951) 782-4200
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2019
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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