<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604207
Report Date: 09/29/2022
Date Signed: 09/29/2022 05:06:07 PM

Document Has Been Signed on 09/29/2022 05:06 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:MANIPON, CHERIFERFACILITY TYPE:
737
ADDRESS:2915 DUCK POND LANETELEPHONE:
(760) 975-7176
CITY:RAMONASTATE: CAZIP CODE:
92065
CAPACITY: 4CENSUS: 4DATE:
09/29/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Soledad Escobar, Executive DirectorTIME COMPLETED:
03:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
An Office Meeting was conducted to review the Stipulation and Waiver and Order adopted on August 22, 2022. The Stipulation and Waiver and Order are for four of the Licensee’s facilities: Liberty Inspiration (374604195), Liberty Empowerment (374604206), Liberty Harmony (374604207), and Liberty Tranquility (374604208).

Those present for the Department of Social Services (Department) were:
Icela Estrada, Interim Assistant Program Administrator
Simon Jacob, Interim Regional Manager
Lizzette Tellez, Licensing Program Manager
Dawn Segura, Licensing Program Analyst

Present for Liberty Residential Services, Inc. (Licensee) were:
Robin Burket, Vice President of Quality and Performance (via telephone)
David Corbett, Director of Operations (via telephone)
Soledad Escobar, Executive Director
Morgan Davis, Quality Assurance Manager
David D. Smith, Program Director of Liberty Tranquility
Cherifer Manipon, Program Director of Liberty Harmony

Present for San Diego Regional Center, via telephone, were:
Kimberly Steitz, Regional Manager
Shelly Gonchoroff, Manager of Client Services
Erik Peterson, Resource Development Manager

Interim Assistant Program Administrator reviewed and discussed the agreed upon and adopted Decision and
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE: DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/29/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: LIBERTY HARMONY
FACILITY NUMBER: 374604207
VISIT DATE: 09/29/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Order dated August 22, 2022. The Executive Director, on behalf of Liberty Residential, understands the following is required for compliance with the Order:

1. The licenses to operate Liberty Inspiration and Liberty Empowerment are revoked from the date of adoption of the Stipulation and Waiver and Order on August 22, 2022.
2. The ordered revocation of the licenses of Liberty Harmony and Liberty Tranquility is stayed for two years from the date of adoption of the Stipulation and Waiver and Order on August 22, 2022, in which the licensee may continue to operate the two facilities under probationary licenses.
3. Licensee shall operate the facilities in full compliance with statutes and regulations that govern the operation of Adult Residential Facilities/Enhanced Behavioral Supports Homes.
4. The Department may conduct unannounced site visits to determine whether the facilities are operating in compliance with statues and regulations that govern the operation of Adult Residential Facilities/Enhanced Behavioral Supports Homes and in compliance with the Stipulation and Waiver and Order adopted on August 22, 2022.
5. Licensee shall ensure that the facilities are clean, safe, sanitary, and in good repair at all times.
6. Licensee shall designate an Orientation Trainer who is responsible for conducting all new hire training and ensuring that regularly scheduled trainings are completed by all staff.
7. Licensee shall designate a Quality Assurance Manager who shall meet with the program director of each facility, monthly, to ensure trainings are completed timely.
8. Licensee shall designate a Quality Assurance Team to conduct quarterly internal audits.
9. Licensee shall provide quarterly audit reports to the Department of Developmental Services, San Diego Regional Center, and the San Diego Adult and Senior Care Regional Office.
10. Licensee’s corporate officers and directors shall receive copies of all quarterly reports and shall discuss the quarterly reports at board meetings.
11. Licensee shall conduct personal rights training for all staff twice a year. [See Stipulation for details]
12. Licensee shall implement the practices regarding medication management noted on the Stipulation and Waiver and Order:
13. Licensee shall conduct monthly monitoring of incident reports at each facility to ensure that reports are submitted in compliance with Title 22 requirements.
14. Licensee shall implement the practices identified in the Stipulation to facilitate communication between direct care staff and management:
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: LIBERTY HARMONY
FACILITY NUMBER: 374604207
VISIT DATE: 09/29/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
15. During the probationary period, Licensee agrees that it shall not receive or hold any license to operate any facility licensed by the Department, other than the probationary licenses granted in the adopted Stipulation and Waiver. Licensee may be issued a new probationary license solely for a change of location.
16. Licensee agrees that the Department may deny any application for licensure submitted after the probationary period, in whole or in part. Licensee understands that if the license, certification, registration, or approval is denied, Licensee shall be entitled to a hearing, subject to the timely filing of a Notice of Defense, after Licensee has been served with a Statement of Issues.
17. The probationary period is tolled during any period when the facilities are not operating. The probationary period shall be extended by the total time during which the facilities are not operating. If an Accusation or Petition to Revoke Probation is filed during the period of probation, the period of probation shall be extended until a final Decision and Order is adopted by the Department.
18. If Licensee successfully complies with the terms of the Stipulation, at the end of two (2) years from the effective date, the conditions imposed upon Licensee and probationary licenses will expire, and Licensee’s licenses shall be restored in full.
19. Licensee agrees that violation of any of the terms of probation or any of the terms of the Stipulation shall constitute sufficient grounds for revocation of the probationary licenses.
20. Licensee understands that nothing in the Stipulation is to be construed to limit the authority of the Department to impose discipline for violations of statues and regulations applicable to Licensee.
21. Licensee understands that a probation monitoring fee for each facility, equal to the annual fee for each license, will apply during the probationary period.
22. Licensee waives the right to a hearing, to present evidence, to cross-examine witnesses, and to obtain further discovery in this matter.
23. Licensee waives all rights of review arising out of this action, the Stipulation, or the Order implementing it.
24. Licensee understands the Stipulation is a public record as required by section 11517(d) of the Government Code.

An exit interview was conducted with Soledad Escobar, Executive Director, and copies of this report and Licensee Rights were provided to the Executive Director. New licenses will be issued with the probationary status indicated. Soledad Escobar’s signature on this form acknowledges receipt of the report and rights.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dawn Segura
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022
LIC809 (FAS) - (06/04)
Page: 3 of 3