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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 370800558
Report Date: 09/10/2021
Date Signed: 09/10/2021 01:48:19 PM

Document Has Been Signed on 09/10/2021 01:48 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:ST PAUL'S MANORFACILITY NUMBER:
370800558
ADMINISTRATOR:DAMIEN RAPPFACILITY TYPE:
740
ADDRESS:2635 SECOND AVETELEPHONE:
(619) 239-2097
CITY:SAN DIEGOSTATE: CAZIP CODE:
92103
CAPACITY: 200CENSUS: 92DATE:
09/10/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:27 PM
MET WITH:Administrator Damien RappTIME COMPLETED:
01:45 PM
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Licensing Program Analysts (LPAs) Rebecca Ruiz and Esther Iriarte-Rendon conducted an unannounced case management visit to conduct a health and safety check and review COVID-19 mitigation strategies. The virtual visit was conducted via FaceTime due to COVID-19 restrictions. LPAs met with, identified themselves, and stated the purpose of the virtual visit to Administrator Damien Rapp.

During today's visit, LPAs toured the facility and interviewed the Administrator. No deficiencies were issued during this visit.

An exit interview was conducted. A copy of this report and Licensee's Rights (9058 01/16) were provided to Administrator Damien Rapp via electronic mail. An email receipt confirms the acknowledgement of these documents.
SUPERVISORS NAME: Alexandre Vo
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2021
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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