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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 365530179
Report Date: 03/06/2024
Date Signed: 03/06/2024 11:50:36 AM

Document Has Been Signed on 03/06/2024 11:50 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:ROSE MANORFACILITY NUMBER:
365530179
ADMINISTRATOR:MORRIS, MELANIEFACILITY TYPE:
735
ADDRESS:9254 KIRKWOOD AVENUETELEPHONE:
(818) 274-1809
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY: 6CENSUS: 3DATE:
03/06/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Oyewole Joseph Jose & Melanie MorrisTIME COMPLETED:
12:00 PM
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On 03/01/2024 at 08:15 AM, Licensing Program Analyst (LPA) Javier Prieto conducted an announced Pre-licensing visit. This is an announced Pre-Licensing visit conducted with Administrator Melanie Morris who assisted in the tour of inside and outside of the facility and the evaluation.

Administrator Morris has the proper posting throughout the facility.

The facility was evaluated in accordance with the California Code of Regulation (CCR), Title 22 Chapter 6, Division 8. Based on the observations and evaluation of the facility this date, the facility’s ready for licensure.



A COMP III orientation was also conducted during today's visit with Administrator Melanie Morris.

Applicant/Administrator Melanie Morris will be notified once facility is licensed.

An exit interview was conducted, and a copy of this report (LIC809) was discussed and provided with Applicant/ Administrator Melanie Morris. .
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2024
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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