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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602232
Report Date: 01/03/2025
Date Signed: 01/03/2025 01:53:25 PM

Document Has Been Signed on 01/03/2025 01:53 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:ROSELAND IIFACILITY NUMBER:
374602232
ADMINISTRATOR/
DIRECTOR:
TIMOTHY CARRASCOFACILITY TYPE:
735
ADDRESS:1262 DIXON WAYTELEPHONE:
(619) 426-6357
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 6CENSUS: 5DATE:
01/03/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:10 PM
MET WITH:Administrator Timothy "TJ" Carrasco and Licensee Liberty Cruz NelsonTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management Welfare Check visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Administrator Timothy "TJ" Carrasco. LPA also spoke with Licensee’s representative, Liberty Cruz Nelson, via phone.

During today’s visit, LPA briefly toured the facility and conducted a Welfare Check on the one (1) client present, finding no safety concerns. The other four (4) clients were still offsite at day program. LPA also reviewed with Licensee a signed/executed CDSS Decision and Order (D&O), which excluded Staff #1 (S1) from employment at the facility. [See LIC811 Confidential Names List for a description of S1.]

Licensee confirmed having prior received a copy of the D&O. Interviews of multiple staff confirmed that S1 has not worked at the facility since 07/22/2023 and is no longer an employee at this facility. Licensee understands that S1 cannot be at facility for the remainder of their life.

LPA also reviewed CDSS’ Guardian System and ensured that all current employees of the facility were both background cleared and associated to the facility's personnel roster, as required.

No deficiencies were observed or cited during today’s visit.

An exit interview was conducted with Timothy “TJ” Carrasco, to whom a copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/03/2025
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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