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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602061
Report Date: 02/20/2024
Date Signed: 02/20/2024 04:23:06 PM


Document Has Been Signed on 02/20/2024 04:23 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:DEL CERRO MANORFACILITY NUMBER:
374602061
ADMINISTRATOR:BENJAMIN D. BARTHFACILITY TYPE:
740
ADDRESS:6667 WANDERMERE CTTELEPHONE:
(619) 741-5232
CITY:SAN DIEGOSTATE: CAZIP CODE:
92120
CAPACITY:6CENSUS: 4DATE:
02/20/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Elda Acosta, Facility ManagerTIME COMPLETED:
04:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required annual inspection and in conjunction conducted this case management visit at the facility. LPA Lopez identified herself and was granted entry by caregivers Lorena Castillo and Blanca Garcia. LPA stated the purpose of the visit and reviewed the basic elements of the visit with facility manager Elda Acosta.

During today’s visit, LPA provided the facility manager Elda Acosta consultation and provided additional information regarding the Department’s website, Records to be Maintained at the Facility – Residential Care Facility for the Elderly (LIC 311F), Changes to Administrator Certification Training Requirements (PIN 23-14-CCLD), Criminal Background Clearance Transfer Request (LIC9182) and Criminal Record Exemption Transfer Request (LIC 9188) Form Updates (PIN 23-08-CCLD), Residential Care Facilities for the Elderly Reference Guide to Administrator, Staff, and Volunteer Training Requirements (PIN 23-16-ASC), and Revised Infection Control Regulations and Permanent Adoption (PIN 23-12-ASC).

No deficiencies were observed or cited during this case management visit. An exit interview was conducted with facility manager Acosta and a copy of this report, along with the Licensee/Appeal Rights (LIC 9058 3/22) were provided to the facility manager at the conclusion of the visit. The signature below confirms the documents were received.
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) -34-3976
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:
DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/20/2024
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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