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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600451
Report Date: 11/21/2024
Date Signed: 11/21/2024 02:26:20 PM

Document Has Been Signed on 11/21/2024 02:26 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:POMERADO MANORFACILITY NUMBER:
374600451
ADMINISTRATOR/
DIRECTOR:
PHILIP CHENNFACILITY TYPE:
740
ADDRESS:16031 POMERADO ROADTELEPHONE:
(858) 673-1969
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 15TOTAL ENROLLED CHILDREN: 0CENSUS: 14DATE:
11/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Administrator Seiko IsoTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Ryan Fulton conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Administrator Seiko Iso. The facility's license shows a maximum capacity of fifteen (15) residents. During today’s inspection there were fourteen 14) residents in care.

LPA and Administrator Seiko Iso toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. clients’ bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all of which are safely stored. Cooking/dining equipment and utensils were present. Toxic chemicals/poisons were locked and inaccessible to residents. Medications were labeled, as required, and stored in locked areas. The facility’s ambient internal temperature was compliant. Hot water temperature at taps accessible to clients were all compliant: Kitchen sink was 109.2 F; bathroom #1 sink was 108.3 F and bathroom #2 sink was 106.2 F bathroom #3 sink was 108.1 F and bathroom sink #4 was 107.8 F.

No pools or bodies of water exist on the premises. Per licensee, no firearms or ammunition are kept at the facility. Carbon monoxide/Smoke detectors, emergency lighting, and facility telephone were all in working order. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

No deficiencies were cited during the inspection. An exit interview was conducted with Administrator Seiko Iso to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.
Jennifer LottTELEPHONE: (619) -76-2311
Ryan FultonTELEPHONE: 619-629-8938
DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
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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