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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600562
Report Date: 12/07/2021
Date Signed: 12/08/2021 08:24:06 AM

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:RICHLAND MANORFACILITY NUMBER:
374600562
ADMINISTRATOR:ZORAIDA PUJICFACILITY TYPE:
740
ADDRESS:949 RICHLAND ROADTELEPHONE:
(760) 744-1484
CITY:SAN MARCOSSTATE: CAZIP CODE:
92069
CAPACITY:6CENSUS: 0DATE:
12/07/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Administrator Zoraida PujicTIME COMPLETED:
01:55 PM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced closure visit to the facility. On November 17, 2021, Administrator Zoraida Pujic confirmed the facility closure via phone call.

LPA was greeted by Administrator Zoriada Pujic, identified himself and disclosed the purpose of the visit. LPA conducted a tour of the facility, confirmed there are no clients residing at the facility, and retrieved the facility license. Clients' relocation and placement was verified prior to this visit.

No deficiencies were observed and as of today's date, the facility is considered closed. A copy of this report and Licensee rights (LIC 9058 01/16) were provided to the Licensee via email. A confirmation email has been requested.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2021
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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