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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603642
Report Date: 10/25/2021
Date Signed: 10/25/2021 04:12:16 PM

Document Has Been Signed on 10/25/2021 04:12 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:LOL - LIFE OF LIBERTY, LLCFACILITY NUMBER:
374603642
ADMINISTRATOR:MUNOZ, CLAUDIAFACILITY TYPE:
775
ADDRESS:320 N. HORNE STREETTELEPHONE:
(760) 433-5411
CITY:OCEANSIDESTATE: CAZIP CODE:
92054
CAPACITY: 100CENSUS: 87DATE:
10/25/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
02:04 PM
MET WITH:Claudia MunozTIME COMPLETED:
02:35 PM
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Licensing Program Analyst (LPA) Ramon Serrano and County of San Diego Public Health Nurses; Robert Montillano and Jennifer West conducted an on-site HAI assessment visit. LPA Serrano and team identified themselves and discussed the purpose of the visit with Program Director (PD) Claudia Munoz.

The Department conducted an on-site visit to provide technical assistance and to evaluate the facility's mitigation plan to include disinfection, testing, vaccination, and screening protocols as well as the use of personal protective equipment (PPE). During today's visit, LPA Serrano and team conducted a walk-though of the facility. A debriefing was conducted with PD Claudia Munoz at the conclusion of the visit.

No deficiencies were cited during today's visit. An exit interview was conducted with PD Claudia Munoz and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to PD, via electronic mail. An electronic receipt of confirmation was requested to be sent by the PD upon receipt of the documents.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE: DATE: 10/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/25/2021
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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