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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604207
Report Date: 04/21/2022
Date Signed: 04/21/2022 06:53:14 PM

Document Has Been Signed on 04/21/2022 06:53 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:LIBERTY HARMONYFACILITY NUMBER:
374604207
ADMINISTRATOR:BAILEY, BRANDYFACILITY TYPE:
737
ADDRESS:2915 DUCK POND LANETELEPHONE:
(760) 975-7176
CITY:RAMONASTATE: CAZIP CODE:
92065
CAPACITY: 4CENSUS: 3DATE:
04/21/2022
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Brandy Bailey, Program DirectorTIME COMPLETED:
04:00 PM
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Regional Manager (RM), Icela Estrada, and Licensing Program Analyst (LPA), Ramon Serrano, conducted an unannounced collateral visit as a follow-up for an unrelated complaint investigation for another facility. RM and LPA were allowed entry by Lead BSP Maribel Calderon, met with Program Director Brandy Bailey and discussed the purpose of the visit.

During the visit, RM and LPA conducted a subsequent interview with staff, toured the facility, and obtained an updated Personnel Report (LIC 500).

An exit interview was conducted with Brandy Bailey A copy of this report along with Licensee Rights (LIC 9098, 01/16) was provided to Brandy Bailey whose signature below verifies receipt of these rights.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE: DATE: 04/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/21/2022
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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