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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 134604744
Report Date: 07/26/2024
Date Signed: 07/26/2024 12:40:53 PM

Document Has Been Signed on 07/26/2024 12:40 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:NOR LIVING IMPERIAL 2 LLCFACILITY NUMBER:
134604744
ADMINISTRATOR/
DIRECTOR:		FARANSO, MARVINFACILITY TYPE:
735
ADDRESS:498 PINTO CT.TELEPHONE:
(619) 335-0566
CITY:IMPERIALSTATE: CAZIP CODE:
92251
CAPACITY: 6CENSUS: 0DATE:
07/26/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:20 PM
MET WITH:Luis Hernandez, Facility ManagerTIME VISIT/
INSPECTION COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced visit to conduct a case management visit. LPA was granted entry by Facility Manager Luis Hernandez. LPA disclosed the purpose of the visit with facility manager Hernandez.

During the visit, LPA toured the interior and exterior of the facility, and spoke with staff manager Hernandez. There are no staff or client information to disclose at this time as there are no clients residing at the facility. Based on today's visit, no deficiencies were observed or cited during this visit.

An exit interview was conducted with Facility Manager Luis Hernandez to whom a copy of this report along with the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit. The signature below confirms the documents were received.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 07/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/26/2024
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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